Staged Breast Reduction or Mastopexy before Nipple-Sparing Mastectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Plastic Surgery
• Breast Surgery

Background:

• Macromastia and breast ptosis are traditionally relative contraindications for nipple-sparing mastectomy (NSM) due to concerns about nipple and flap viability.
• Staged breast reduction or mastopexy (SBRM) before NSM shows promise in reducing complications, but data is limited.

Purpose of the Study:

• To systematically review and meta-analyze reconstructive outcomes and complication rates after staged breast reduction or mastopexy (SBRM) prior to nipple-sparing mastectomy (NSM).
• To evaluate the safety and efficacy of SBRM in optimizing breast morphology for NSM.

Main Methods:

• Systematic review of PubMed, Scopus, and Cochrane databases for studies on SBRM followed by NSM.
• Descriptive analysis of surgical techniques and outcomes.
• Random-effects model meta-analysis to assess complication rates, including nipple and mastectomy flap necrosis.

Main Results:

• Eleven studies involving 542 breasts (288 patients) were analyzed; 79.2% of mastectomies were prophylactic.
• Staged breast reduction was performed in 75.2% of patients, with a mean reduction of 354.4g per breast.
• Meta-analysis revealed low complication rates: nipple necrosis (3.1%) and mastectomy flap necrosis (2.4%).

Conclusions:

• Systematic review and meta-analysis confirm low rates of nipple and mastectomy flap necrosis following SBRM before NSM.
• Prophylactic optimization of breast morphology through SBRM can enhance outcomes and broaden candidacy for nipple-sparing procedures.