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- W4319662410 abstract "Objective: Nipple-sparing mastectomy (NSM) is psychologically advantageous and can result in superior cosmetic outcomes. Pre-existing ptosis can result in suboptimal shape of reconstructed breast with lateral nipple displacement. To prevent this deformity, skin tightening with nipple lift are indicated. However, concurrent mastopexy with NSM may lead to ischemic complications. This study reviewed outcomes of breast ptosis correction in immediate prosthetic breast reconstruction after NSM. Methods: All patients who underwent immediate breast reconstruction with tissue expander (TE) or direct-to-implant (DTI) after NSM by the senior author between April 2010 and January 2021, were included in this study. Procedures were stratified into Lift or No-Lift cohorts. Irrespective of Lift or No-Lift, prepectoral and subpectoral implant placement was also analyzed, as was ADM use versus No-ADM. Complications within 30 days were analyzed. Minor complications included erythema, seroma, flap necrosis, nipple necrosis, and prescription of extra antibiotics. Major complications included hematoma, dehiscence, infection, hospitalization, necrosis requiring surgery, any surgical intervention, capsular contracture, and implant loss. Ecchymosis was individually measured. Results: A total of 143 patients underwent immediate reconstruction of 228 breasts after NSM. In 23 patients and 34 breasts, correction of breast ptosis was performed. The remaining 120 patients and 194 breasts did not undergo NAC elevation. Implants were placed in prepectoral position in 119 procedures and submuscular plane in 109. Mean patient age was 49 ± 10 years and BMI 25.9 ± 4.8. Average ptosis grade was 1 ± 1, and mastopexy lift was 3.73 ± 2.12 cm. There was no significant difference in infection rates (8.8% vs 10.3%, p = NS), nor other major (57.7% vs 47.1%, p = NS) and minor complications (76.5% vs 74.7%, p = NS) between Lift and No-Lift groups. Ecchymoses were increased with No-Lift (43.3% vs 11.8%, p < 0.001). All reconstructions were also analyzed based on anatomic plane of implant placement, which demonstrated no difference in major complications. However, loss of implant (27.7% vs 16.5%, p = 0.042) and seroma formation requiring in-office aspiration (28.6% vs 10.1%, p < 0.001) as individual outcomes did occur more with prepectoral than subpectoral planes, as did ecchymoses (56.3% vs 19.3%, p < 0.001). As another distinct analysis, ADM use was associated with more nipple necrosis (26% vs 14.5%, p = 0.049), but this was partial thickness necrosis which did not require operative intervention. Conclusion: Mastopexy at the time of immediate prosthetic breast reconstruction after NSM is safe, with complications similar to a no-nipple-lift technique irrespective of plane of implant placement or ADM use. Corresponding Author: Elizabeth Bushong, 15 Michigan St NE, Grand Rapids, MI 49503, [email protected], (760) 285-4085" @default.
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- W4319662410 date "2023-02-01" @default.
- W4319662410 modified "2023-09-25" @default.
- W4319662410 title "Correction of Breast Ptosis in Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy" @default.
- W4319662410 doi "https://doi.org/10.1097/01.gox.0000920824.89539.29" @default.
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