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Ann Plast Surg. 2012 Oct;69(4):425-8. doi: 10.1097/SAP.0b013e31824a45be.

Nipple-sparing mastectomy and immediate free-flap reconstruction in the large ptotic breast.

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Institute of Reconstructive Plastic Surgery, Department of Plastic Surgery, New York University Langone Medical Center, New York Eye & Ear Infirmary and Lenox Hill Hospital, New York, NY 10016, USA.


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.

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