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. 2023 Apr 24;12(9):3082.
doi: 10.3390/jcm12093082.

Mastopexy Strategies for Ptotic Breasts in Patients Choosing Autologous Reconstruction Following Prophylactic Mastectomy

Charalampos Varnava  1   2   3 , Miriam Bogusch  2 , Sascha Wellenbrock  1   2   3 , Tobias Hirsch  1   2   3 , Philipp Wiebringhaus  1   2   3 , Maximilian Kueckelhaus  1   2   3
Affiliations

Mastopexy Strategies for Ptotic Breasts in Patients Choosing Autologous Reconstruction Following Prophylactic Mastectomy

Charalampos Varnava et al. J Clin Med. .

Abstract

Background: Autologous breast reconstruction is a reliable solution for many patients after mastectomy. While this technique represents a standardized approach in many patients, patients with ptotic breasts may require a combination of procedures to achieve an aesthetically pleasing result.

Methods: We reviewed the mastectomy and free-flap breast reconstruction procedures performed at our institution from 2018 to 2022 in patients with ptotic breasts. The technique used to address the ptosis was put in focus as we present the four strategies used by our reconstructive surgeons. We performed two different one-stage and two different two-stage procedures. The difference between the two-stage procedures was the way the nipple areola complex was treated (inferior dermal pedicle or free skin graft). The difference between the one-stage procedures was the time of execution of the mastopexy/breast reduction (before or after the mastectomy and autologous breast reconstruction).

Results: The one-stage procedure was performed with a free NAC in three patients and with a pedicled NAC in five patients. The two-stage procedure was performed in seven patients, with six of them undergoing mastopexy before and one patient undergoing mastopexy after the bilateral mastectomy and autologous reconstruction. No flap loss or total loss of the nipple areola complex occurred. Partial NAC loss was observed in five breasts in the single-stage group without any occurrence in the double-stage group.

Conclusions: While both one- and two-stage procedures were performed in a safe fashion with satisfactory results at our institution, larger trials are required to determine which procedure may yield the best possible outcomes. These outcomes should also include oncological safety and patient-reported outcomes.

Keywords: DIEP; breast reconstruction; mastopexy; microsurgery; post bariatric; ptosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 3
Figure 3
One-stage procedure—bilateral mastectomy, mastopexy with inferior dermal NAC pedical, DIEP. Top row: preoperatively; bottom row: postoperatively.
Figure 4
Figure 4
One-stage mastectomy, Wise pattern skin excision with inferior dermal NAC pedicle. From left to right: preoperatively/bilateral partial NAC necrosis 16 days after initial surgery/4 months after necrosis excision and 6 months after initial surgery.
Figure 5
Figure 5
One-stage procedure—bilateral mastectomy, mastopexy with free skin graft, DIEP. Top row: preoperatively; bottom row: postoperatively.
Figure 6
Figure 6
Two-stage procedure—1. breast reduction, 2. bilateral mastectomy and DIEP. Top row: preoperatively; middle row: postoperatively after breast reduction; bottom row: postoperatively after mastectomy and autologous breast reconstruction.
Figure 7
Figure 7
Two-stage procedure—1. bilateral mastectomy and DIEP, 2. mastopexy. Top row: preoperatively; middle row: postoperatively after mastectomy and autologous breast reconstruction; bottom row: postoperatively after mastopexy.
Figure 1
Figure 1
The techniques used in our clinic. The illustration on the left demonstrates the preoperative condition of the patients. (A) One-staged procedure with inferior pedicled NAC—1: preoperative markings; 2: intraoperatively; 3: exposure of the internal mammary vessels (IMV); *: inferior dermal pedical. (B) One staged procedure with free NAC skin graft—1: preoperative markings; 2: intraoperatively; 3: exposure of the IMV; *: breast tissue. (C) Two-staged procedure—mastopexy before mastectomy and reconstruction—1: breast after mastopexy/reduction; 2: mastectomy; 3: exposure of the IMV; *: breast tissue. (D) Two-staged procedure—mastopexy/reduction after mastectomy and reconstruction—1: de-epithelialized breast after reconstruction; 2: mastopexy/reduction; 3: postoperatively; *: DIEP flap.
Figure 2
Figure 2
Intraoperative view (a–c,e) and markings (d) of the Wise pattern excision and the inferior dermal NAC pedicle. The last picture (f) demonstrates the intraoperative result after bilateral Wise pattern excision with pedicled NAC, mastectomy, and breast reconstruction with DIEP.
See this image and copyright information in PMC

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