Preshaping in two-stages improves risk-reducing mastectomy results for women with large breasts

Liz Meszaros, MDLinx | August 31, 2017

Targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction is safe in women with large breasts who have chosen to undergo risk-reducing mastectomy to prevent breast cancer, and can successfully be performed with a 3- to 4-month wait between operations, according to results published in the journal Plastic and Reconstructive Surgery. Based on these results and the superior cosmetic outcomes achieved, these researchers have adopted this two-stage approach as their standard of care in these patients.


Using a two-step approach

Targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction is safe, and provides excellent cosmetic results.

With this study, researchers from Telemark Hospital, Skien, Norway, sought to determine whether targeted preshaping mastopexy/reduction is adequate preparation for successful nipple-sparing mastectomy/direct-to-implant reconstruction.

They included 22 patients (mean age: 43 years; median BMI: 30 kg/m2; 6 smokers; 1 hypertensive) who sought to undergo risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction who were unfit to undergo a once-stage procedure based on their previous experience. Patients were offered a targeted two-stage, risk-reducing mastopexy/reduction, followed by delayed secondary nipple-sparing mastectomy and direct-to-implant reconstruction. All patients underwent follow-up at 3 weeks, and 6 or 12 months.

In all, 44 reconstructions were performed and successful, with no failure or nipple-areola complex losses. In two patients, reoperation was necessary due to hematoma and fat necrosis.

“We planned the procedures 3 months apart to allow the scarring and hyperemia to subside. However, most patients wanted to wait a little longer for completion of their nipple-sparing mastectomy/direct-to-implant reconstruction, which explains the calculated median time of 4 months between procedures. Patients requesting a prophylactic mastectomy are generally healthy and provide optimal conditions for observing the results of an operative method in terms of safety and an outcome unbiased by the effects of cancer therapy,” wrote lead researcher Gudjon Gunnarsson, MD, Telemark Hospital, and colleagues.

Dr. Gunnarsson and fellow researchers also stressed the importance of proper patient selection, and the challenging nature of such procedures in large and ptotic breasts, in which disappointing cosmetic results and higher complication rates are common.

“We have attempted various approaches to solve this challenging task in the past, and most attempts have led to tedious secondary corrective procedures. The current method has improved our results, resulting in fewer complications and better aesthetics and has been integrated into our standard of care based on the results of this series,” they concluded.