Ptotic versus Nonptotic Breasts in Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction

In recent years, nipple-sparing mastectomy followed by implant-based breast reconstruction has gained popularity due to improved cosmetic and psychological benefits. However, patients with ptotic breasts remain the main challenge for surgeons, owing to the potential risk of postoperative complications.

A retrospective chart review was performed for patients who underwent nipple-sparing mastectomy and prepectoral implant-based breast reconstruction between March 2017 and November 2021. Patient demographics, incidence of complications, and quality of life assessed using the BREAST-Q questionnaire were compared between the two different incisions [inverted-T for ptotic versus inframammary fold (IMF) for nonptotic breasts].

A total of 98 patients were examined: 62 in the IMF cohort and 36 in the inverted-T cohort. The results demonstrated equivalence in the safety metrics between the two groups, including hematoma (p=0.367), seroma (p=0.552), infection (P = 1.00), skin necrosis (P = 1.00), local recurrence (P = 1.00), implant loss (P = 0.139), capsular contracture (P = 1.00), and nipple-areolar complex necrosis (P = 0.139). The BREAST-Q scores were equally high in both groups.

Our results suggest that inverted-T incision for ptotic breasts is a safe modality with similar complication rates and high aesthetic results compared with IMF incision for nonptotic breasts. A higher rate of nipple-areolar complex necrosis in the inverted-T group, although not significant, should be considered during careful preoperative planning and patient selection.