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J Reconstr Microsurg
DOI: 10.1055/a-2508-6495
Review Article

Optimal Strategies for the Management of Macromastia and Breast Ptosis for Patients Undergoing Nipple-sparing Mastectomy

Andrea A. Moreira 
1   Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
2   Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
,
Erica Kozorosky
3   Department of Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Suzanne B. Coopey
2   Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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Abstract

High-volume breasts pose challenges for nipple-sparing mastectomy (NSM) due to their large size, indistinct tissue boundaries, and high degree of ptosis. Historically, NSM was not considered feasible for such cases, but advancements in surgical techniques have expanded eligibility criteria.

We developed a surgical algorithm for patients with macromastia and ptosis undergoing NSM. We also outline techniques for preserving the nipple–areolar complex (NAC) based on the severity of macromastia and breast ptosis, especially when immediate mastopexy/reduction is required during mastectomy. The proposed algorithm provides a practical guide for surgeons managing these complex cases.

By employing carefully selected approaches, it is possible to successfully preserve the NAC in high-volume breasts undergoing NSM. This broader eligibility criteria not only accommodates a more diverse patient population but also enhances their quality of life and improves aesthetic outcomes.

Advancements in surgical techniques have made NSM a viable option for breast reconstruction in high-volume breasts. By addressing challenges and preserving the NAC through carefully selected approaches, surgeons can improve outcomes and quality of life for patients undergoing NSM.

Keywords

breast reconstruction - implant-based breast reconstruction - breast reconstruction in large and ptotic breasts


Publikationsverlauf

Eingereicht: 10. April 2024

Angenommen: 23. Dezember 2024

Artikel online veröffentlicht:
13. Februar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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