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Expanded Algorithm and Updated Experience with Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction Mammaplasty in the Large or Ptotic Breast

Economides, James M., M.D.; Graziano, Francis, B.S.; Tousimis, Eleni, M.D.; Willey, Shawna, M.D.; Pittman, Troy A., M.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 688e–697e
doi: 10.1097/PRS.0000000000005425
Breast: Original Articles

Background: Staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty was first described in 2011 by Spear et al. to expand the indications for nipple-sparing mastectomy to women with large or ptotic breasts. Since that time, the authors have revised their treatment algorithm and technique to enhance oncologic safety and improve wound healing complications.

Methods: An institutional review board–approved retrospective review was undertaken of all patients undergoing staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty at a single institution from July of 2011 through July of 2016. Management followed an updated treatment protocol to improve surgical and oncologic outcomes.

Results: Twenty-six patients (50 breasts) were identified who underwent staged nipple-sparing mastectomy. Five breasts (10 percent) required reoperation for a complication such as infection or tissue necrosis. Two devices (4 percent), both in the therapeutic cohort, required explantation because of infection. Skin flap necrosis and nipple-areola complex necrosis were each seen in two breasts (4 percent). Infection was seen in four breasts (8 percent), and wound healing complications were seen in only two breasts (4 percent).

Conclusions: The authors offer their updated treatment algorithm for a staged approach to nipple-sparing mastectomy for patients with macromastia or grade II or III ptosis. Their results build on previously published reports demonstrating the safety and efficacy of this approach for nipple preservation and oncologic management in this patient population.


Washington, D.C.

From the Department of Plastic Surgery and the Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital.

Received for publication October 22, 2017; accepted July 31, 2018.

Disclosure: Dr. Pittman is a consultant and advisory board member for Stryker and Sientra. Dr. Willey is a consultant for Invuity and Medtronic Advanced Energy. She is on the speaker’s bureau for Genentech, Invuity, Medtronic Advanced Energy, and Pacira. She is on the Scintific Advisory Board of TransMed 7. The remaining authors have no disclosures to report. No financial support was provided for this research.

Troy A. Pittman, M.D., Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, 1-PHC, Washington, D.C. 20007,

©2019American Society of Plastic Surgeons