• Scott L Spear, Steven J Rottman, Laura A Seiboth, and Catherine M Hannan.
• Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
• Plast. Reconstr. Surg. 2012 Mar 1; 129 (3): 572-581.

BackgroundTo address those patients who do not meet anatomical criteria for nipple-sparing mastectomy, the authors use a staged approach: (1) mastopexy or breast reduction, (2) nipple-sparing mastectomy through the mastopexy incisions after a minimum of 3 to 4 weeks, and (3) the final reconstruction.MethodsFifteen patients underwent nipple-sparing mastectomy at Georgetown University Hospital between 2007 and 2010 after planned or unrelated mastopexy or reduction. An institutional review board-approved retrospective chart review recorded demographic information and outcomes such as skin necrosis and device failure.ResultsFifteen patients (24 breasts) underwent nipple-sparing mastectomy after mastopexy or reduction with an average follow-up of 13 months. The staged procedure was planned in 10 patients [19 breasts (79 percent)] and unplanned, or coincidental, in five [five breasts (21 percent)]. The mastectomy was prophylactic in 17 breasts (71 percent) and therapeutic in seven (29 percent). Four of the 24 operated breasts (17 percent) experienced a complication. Two patients [two breasts (8 percent)] developed skin flap necrosis. Two patients [three breasts (13 percent)] developed minimal partial nipple-areola complex necrosis. One patient [one breast (4 percent)] had an expander explanted for infection related to skin flap necrosis. Fourteen patients [23 breasts (96 percent)] successfully recovered following nipple-sparing mastectomy and prior mastopexy or reduction without residual effects of nipple-areola complex or skin flap necrosis.ConclusionsThe authors are comfortable offering the staged approach to nipple-sparing mastectomy to patients with moderately large or ptotic breasts. It may not be suitable for the very large or ptotic breast.Clinical Question/Level Of EvidenceTherapeutic, IV.

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