Clinical PapersNipple-Sparing Mastectomy and Immediate Free-Flap Reconstruction in the Large Ptotic BreastSchneider, Lisa F. MD*; Chen, Constance M. MD, MPH†; Stolier, Alan J. MD‡; Shapiro, Richard L. MD§; Ahn, Christina Y. MD*; Allen, Robert J. MD*Author Information From the *Institute of Reconstructive Plastic Surgery, Department of Plastic Surgery, New York University Langone Medical Center, New York; †New York Eye & Ear Infirmary and Lenox Hill Hospital, New York, NY; ‡Omega Hospital, Metairie, LA; and §New York University Cancer Institute, New York University Langone Medical Center, New York, NY. Received January 6, 2012, and accepted for publication, after revision, January 9, 2012. Presented at the 28th Annual Meeting of the Northeastern Society of Plastic Surgeons, Amelia Island, FL, October 20–23, 2011. Conflicts of interest and sources of funding: none declared. Reprints: Robert J. Allen, MD, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, 560 First Ave, THC-169, New York, NY 10016. E-mail: [email protected]. Annals of Plastic Surgery: October 2012 - Volume 69 - Issue 4 - p 425-428 doi: 10.1097/SAP.0b013e31824a45be Buy Metrics Abstract Because of increased risk for nipple necrosis, many surgeons believe large ptotic breasts to be a relative contraindication to nipple-sparing mastectomy (NSM). A retrospective review was performed on 85 consecutive patients who underwent NSM with 141 immediate perforator free-flap breast reconstructions. We analyzed the subset of patients with large ptotic breasts, defined as cup size C or greater, sternal notch to nipple distance greater than 24 cm and grade 2 or 3 breast ptosis. Of the 85 patients, 19 fit the inclusion criteria. Breast cup size ranged from 34C to 38DDD. There was 1 case of nipple necrosis in the patient with previous breast radiation (5%), 1 hematoma (5%), and no flap losses. Five (26%) patients underwent subsequent mastopexy or breast reduction, a mean of 6.6 months after the primary procedure. We demonstrate that NSM and free-flap breast reconstruction can be safely and reliably performed in selected patients. © 2012 Lippincott Williams & Wilkins, Inc.