Skin reducing nipple sparing mastectomy and implant reconstruction: Surgical options and risk factors for complications in the larger ptotic breast

Abstract

Implant breast reconstruction is the most common form of breast reconstruction worldwide. Nipple sparing mastectomy (NSM) has been shown to be oncologically safe in appropriately selected patients and provide superior aesthetic outcomes. Patients with larger ptotic breasts traditionally have not been candidates for nipple sparing mastectomies due to higher rates of nipple and skin flap necrosis, leading to reconstructive failure, and difficulty positioning the nipple areolar complex (NAC) on the breast mound. Patient factors, breast factors and adjuvant oncological therapies should all be taken into account to determine the safest treatment for the patient. Surgical options can be grouped into single staged procedures with skin reducing incisions and direct to implant reconstruction versus staged procedures. This review article aims to highlight risk factors associated with surgical complications and examine the surgical options available to manage this complex problem with their associated outcomes.