Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Table 5

Table reviewing all of the studies published on nipple-sparing mastectomy in large-volume, ptotic breasts from 1970 to 2016.

	Technique	Reconstruction	Sample size (number of breasts)	Indication	Ptosis/breast volume	Partial NAC necrosis	Total NAC necrosis	Other complications
Simultaneous mastopexy and NSM
Goulian & McDivitt, 1972	SCM with reduction mastopexy	Implant; None	24	Risk reduction	Medium-large; Not specified	None	None	Hematoma (NR)
Biggs et al., 1977	SCM with reduction mastopexy	Implant	33	NR	Not specified; Min-Mod ptosis	None	None	Partial flap necrosis (1); Capsular contractures (8); Atrophy requiring excision (1); Explant (1)
Jarrett et al., 1978	SCM, reduction mastopexy, and free nipple graft	Implant	44	Risk reduction	Large volume; Severe ptosis	None	None	NR
Gibson, 1979	SCM with reduction mastopexy	NR	NR	Risk reduction	Not specified	None	None	NR
Rusby & Gui, 2010	NSM with reduction mastopexy	Expander	16	Risk reduction	NR; NR	NR	6.3%	None
Nava et al., 2011	NSM with reduction mastopexy	Implant	13	Therapeutic	NR; NR	NR^#	NR^#	NR^#
Rivolin et al., 2012	NSM with periareolar pexy	Implant	22	Therapeutic	Medium-large volume; Moderate ptosis	13.6%	4.6%	None
Al-Mufarrej et al., 2013	NSM with reduction mastopexy	Expander; Implant	48	Risk reduction	Large volume; Moderate	8.3%	4.2%	Infected implant (2.1%); Implant rupture (14.6%); Hematoma (2.1%); Capsular contracture (4.2%)
Pontell et al., 2016 (this report)	NSM with reduction mastopexy	Expander; DIEP Flap	16	Risk reduction; Therapeutic	Large volume; Grade II/III ptosis	0%	0%	Hematoma; Seroma; Mastectomy flap necrosis
Staged mastopexy and NSM
Schneider et al., 2012	NSM with immediate flap placement and staged reduction mastopexy	TUG Flap; DIEP Flap	34	NR	Large volume; Grade II/III ptosis	None	3%	Hematoma (3%)
DellaCroce et al., 2015	NSM with immediate flap placement and staged reduction mastopexy	DIEP Flap; SGAP Flap	110	Risk reduction; Therapeutic	Medium-large volume; Grade II/III ptosis	None	None	Partial mastectomy flap necrosis (3.6%); Incisional dehiscence (8%); Hematoma (2.7%); Partial flap necrosis (1.8%)
Spear et al., 2012	Reduction mastopexy followed by NSM	Implant; Tissue expander	24	Risk reduction; Therapeutic	Medium volume; Grade II/III ptosis	12.5%	None	Breast infection (8%); Skin flap necrosis (17%); Explant (4%)

NAC: nipple-areolar complex; NSM: nipple-sparing mastectomy; SCM: subcutaneous mastectomy; NR: not reported; DIEP: deep inferior epigastric perforator; TUG: transverse upper gracilis; SGAP: superior gluteal artery perforator. ^#Complications were not stratified by NSM (SRM) versus SSM status. This study mentions the exclusion of one patient who had total NAC necrosis. These rates exclude the patients who were smokers, including patients with partial and total NAC necrosis rates of 12.5% and 18.7%, respectively.