Nipple-sparing mastectomy (NSM) and reconstruction is challenging in ptotic patients with additional risk factors. Here, these problems are addressed with a staged strategy that extends NSM and reconstruction to patients with grade 3 ptosis and additional risk factors of diabetes, obesity, and macromastia. Three stages are used to perform a mastectomy, reposition the nipple, and reduce the skin envelope using the Wise pattern. This is followed by definitive implant placement in a final fourth stage. All patients successfully completed their reconstructions without a single instance of implant loss. Using a staged approach, NSM and reconstruction in high-risk ptotic patients is feasible. This is facilitated by using multiple surgical delays and insuring a well-healed skin envelope and optimal nipple position before any prosthetic device is placed.
From the Georgia Breast Surgery, PC, Lawrenceville, Ga.
Published online 10 May 2018.
Received for publication October 5, 2017; accepted March 20, 2018.
Disclosure: The author has no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the author.
Jean-Claude Schwartz, MD, PhD, Georgia Breast Surgery, PC, 631 Professional Drive, Suite 240, Lawrenceville, GA 30046, E-mail: firstname.lastname@example.org
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