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Updated: Jun 3, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction

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Skin-reducing mastectomy: new refinements.

Livio Colizzi1, Davide Lazzeri, Tommaso Agostini

  • 1Breast Cancer Surgical Unit, Hospital of Pisa, Via Roma 32, Pisa, Italy. lcolizzi@libero.it

Journal of Plastic Surgery and Hand Surgery
|March 31, 2011
PubMed
Summary
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Skin-reducing mastectomy offers an improved single-stage solution for cosmetic concerns in larger breasts undergoing skin-sparing mastectomy. This technique enhances breast shape and implant coverage while maintaining oncological safety.

Area of Science:

  • Plastic Surgery
  • Oncologic Surgery

Background:

  • Skin-sparing mastectomy (SSM) can result in cosmetic inadequacy, particularly in heavy, pendulous breasts.
  • The Type IV Wise pattern SSM presents challenges with scar visibility and lower-medial quadrant volume.
  • Implant coverage and aesthetic outcomes are critical considerations in breast reconstruction.

Purpose of the Study:

  • To evaluate the efficacy and aesthetic outcomes of a modified skin-reducing mastectomy technique.
  • To address the cosmetic limitations of traditional Type IV Wise pattern SSM in medium to large breasts.
  • To refine surgical methods for improved implant coverage and natural breast contour.

Main Methods:

  • A modified skin-reducing mastectomy technique was performed on 18 women (22 procedures).

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  • The dermal flap mobilization was refined by detaching its lateral insertion along the inframammary fold.
  • Serratus anterior muscle preservation and medial force vectoring were employed to optimize outcomes.

    • Main Results:

    • The modified technique effectively filled the lower-medial quadrant, improving breast volume and shape.
    • Enhanced dermal flap mobilization facilitated closure without extensive serratus anterior manipulation.
    • Reduced implant lateral dislocation and improved lateral breast contour were observed, leading to a more natural aesthetic.
    • The procedure demonstrated oncological safety and satisfactory implant coverage.

    Conclusions:

    • Skin-reducing mastectomy, with the described modification, is an oncologically safe and aesthetically superior alternative for medium to large breasts.
    • The technique effectively resolves cosmetic issues associated with Type IV Wise pattern SSM.
    • Single-stage mastectomy and reconstruction promote positive patient psychological outcomes.