With the increasing popularity and acceptance of nipple-sparing mastectomy with immediate reconstruction comes an associated higher complication rate of nipple and skin necrosis. Historically, management of this risk has been addressed by predictive technologies or staged surgery with placement of an initial tissue expander. Certain high-risk patients, such as those with large cup size, previous surgery, or previous radiation, may not even be considered for an immediate nipple-sparing mastectomy approach due to even higher rates of complications. This report details a delay technique that allows safe preservation of the nipple-sparing mastectomy tissues, even in high-risk individuals, and facilitates straight-to-implant reconstruction without the need for tissue expansion. The aesthetic benefits, time savings, and acceptable complication profile in this series are presented.
Coding Perspective for this article is on page 979.
From Duke University Medical Center.
Received for publication July 7, 2014; accepted September 10, 2014.
Presented in part at the North Carolina Society of Plastic Surgeons Annual Meeting, in Kiwah, S.C., October of 2013.
Disclosure: The author is a member of the speakers bureau of LifeCell, Bridgewater, N.J. (AlloDerm, SPY), and a consultant for Novadaq, Bonita Springs, Fla. (SPY). The author has no financial interest to declare in relation to the content of this article.
Michael R. Zenn, M.D., M.B.A., Duke University Medical Center, 136 Baker House, Trent Drive, Durham, N.C. 27710-3358, firstname.lastname@example.org