SUMMARY

Introduction: Current breast cancer treatment trends advocate nipple-sparing mastectomy (NSM) as the preferred technique for selected patients. A considerable and ptotic breast is often considered a relative contraindication for NSM due to the increased risk of skin and nipple necrosis.

Methods: A retrospective review was performed for patients who underwent immediate prepectoral breast reconstruction (PPBR) after NSM with Wise-pattern incision between February 2020 and February 2023 at our institution. This procedure was offered to patients with grade IIor III ptosis or large breasts eligible for NSM for therapeutic or prophylactic purpose. Exclusion criteria comprised a preoperative nipple-sternal notch distance greater than 30 cm, previous radiotherapy, pinch test < 1 cm, body mass index (BMI) greater than 34 and active smoke. We present our short-term results with this technique.

Results: During the study period, 62 patients (76 breasts) had NSM with Wise-pattern incision. Patients had immediate PPBR with implant or tissue expander, both entirely wrapped with ADM. The median age of the patients was 57.0 years [The Interquartile Range (IQR 50.0–68.6)] with a median BMI of 25.5 (IQR 23.3–28.4). The median mastectomy specimen weight was 472 g (341−578). Median implant volume was 465 g (IQR 370–515). Major complications occurred in 8 patients (10.5%). Three patients experienced total nipple-areolar complex (NAC) necrosis Current trends in breast cancer treatment advocate nipple- sparing mastectomy (NSM) as the technique of choice for selected patients. Substantial evidence has demonstrated that the preservation of the nipple-areolar complex (NAC) is oncologically safe in selected patients.1–3Additionally, NSM has a positive impact on the patient’s quality of life, improving the psychological and sexual well-being3,4compared to skin-sparing mastectomy (SSM). This improvement leads to higher satisfaction regarding the reconstruction.