Reconstruction of Large Ptotic Breasts After Nipple-Sparing Mastectomy: A Modified Buttonhole Technique

As nipple-sparing mastectomies continue to gain popularity, the reconstruction of a large ptotic breast remains a challenge. The purpose of this article is to introduce the senior author's modifications of a novel technique previously described for addressing the redundant skin envelope in ptotic breasts during immediate reconstruction after nipple-sparing mastectomy. In this review, 15 patients (29 breasts) were reconstructed using our modified "buttonhole" technique. Postoperative complications included 1 case of nipple necrosis and 1 case of tissue expander loss secondary to infection. All patients eventually underwent full expansion and exchange to permanent implants. Ultimately, this surgical approach offers immediate reconstruction after nipple-sparing mastectomy while concurrently performing a safe and aesthetically pleasing mastopexy with acceptable risk to the nipple-areolar complex.