Affiliation:
1. Department of Plastic Surgery, Oregon Health and Science University , Eugene, OR , USA
Abstract
Abstract
Background
Classically large, ptotic breasts have been a contraindication for nipple preservation during breast reconstruction. We present a technique of “smile mastopexy” (SM) to reduce the excess skin in both vertical and transverse directions, avoid a T-junction, preserve the nipple areolar complex, and add thickness to the upper pole of the breast at the time of mastectomy.
Objectives
The authors sought to demonstrate the safety and reliability of a novel technique that addresses the excess skin envelope during breast reconstruction while preserving the nipple-areola complex in large, ptotic breasts.
Methods
This is a retrospective review of a single surgeon performing the SM for immediate 2-stage prosthetic breast reconstruction. All were performed in the prepectoral pocket without utilization of acellular dermal matrices.
Results
Thirty patients (total 54 breasts) aged a mean 50 years with BMI of 30 kg/m2 and mastectomy specimen weight of 683 g were included. All had class 2 or 3 ptosis. There were no cases of complete nipple loss. The overall complication rate was 14.8%. There were 3 explantations: 1 (1.8%) due to infection and 2 (3.7%) due to implant exposure. Radiation was associated with a higher complication rate.
Conclusions
The SM is a safe and reliable technique in large, ptotic breasts during prosthetic breast reconstruction. It preserves the nipple-areola complex, reduces the excess skin envelope, adds thickness to the upper pole, and allows for future skin revisions with the same scar if necessary.
Level of Evidence: 4
Publisher
Oxford University Press (OUP)
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