Extreme Nipple-Sparing Mastectomy: Feasibility of Nipple Preservation and Immediate Reconstruction in Breasts Weighing Over 600 Grams in a Cohort of 43 Patients

Background: Limited data exist on complication rates in nipple-sparing mastectomy (NSM) in patients with large-volume breasts. Our aim was to evaluate the early complication rates of NSM with immediate reconstruction in a consecutive cohort of patients with large-volume breasts.

Methods: After IRB approval, patients treated with prophylactic or therapeutic NSM and immediate reconstruction from January 2020 to June 2022 at our health network were identified. Patients with breast weights > 600 g (the extreme NSM group) were compared to patients with breast weights of 600 g or less (the average-volume NSM group).

Results: A total of 184 patients underwent NSM with immediate reconstruction. Forty-three of 184 (23.37%) NSM patients had breast weights > 600 g. Of these, 30 patients had bilateral NSM, for a total of 73 breasts with volumes over 600 g, ranging from 603 to 1658 g. There were significantly more total complications in the extreme NSM compared to average-volume NSM groups (41.86% vs. 21.99%, p = 0.009852). When broken down into major and minor complications, the extreme NSM group had significantly more major complications than the average-volume NSM group (27.91% vs. 12.86%, p = 0.01072), but no difference in minor complications (13.95% vs. 9.29%, p = 0.2205). Overall, one (2.33%) patient in the extreme NSM group had a reconstruction failure, compared to three (2.14%) in the average-volume NSM group. Only two of 43 (4.65%) patients in the extreme NSM group lost their nipples due to total or partial nipple necrosis.

Conclusions: NSM with immediate reconstruction was successful in the majority of patients with large-volume breasts. The rate of nipple loss was acceptably low. Women with breast volumes larger than 600 g who are motivated to save their nipples at the time of mastectomy could be offered NSM.