Nipple-sparing mastectomy in the large, ptotic breast

Abstract

Nipple-sparing mastectomy with expander/implant-based reconstruction in selected patients is an accepted method for the treatment of breast cancer. Patients with different breast sizes ranging from small to large and with various degrees of ptosis may be reconstructed with expander/implant following inframammary nipple-sparing mastectomy. Patients with large or very large, ptotic breasts who are to undergo mastectomy will, however, require a mastopexy if the nipple-areola is to be spared. The mastopexy procedures previously described for nipple-sparing mastectomy, either done as a separate procedure prior to the mastectomy or simultaneously with the mastectomy, cannot be performed on patients with large ptotic breasts. The buttonhole mastopexy technique allows a major lift to be carried out at the time of nipple-sparing mastectomy in patients with large breasts. The indications, technique, and results of combined primary buttonhole mastopexy and nipple-sparing mastectomy are described in this chapter. Also discussed is secondary mastopexy in the management of patients with ptotic breasts after the completion of staged implant reconstruction.