Nipple-Preserving Skin-Reducing Mastectomy in Ptotic Breasts: A Systematic Review and Meta-analysis

Skin-reducing mastectomy (SRM) represents a surgical option that provides patients with ptotic breasts the advantage of undergoing simultaneous nipple-preserving mastopexy in conjunction with mastectomy. Nonetheless, existing data, primarily derived from single-center studies, are characterized by limited patient cohorts. Therefore, this study examines the complications associated with SRM.

We conducted a systematic review of MEDLINE and Embase to evaluate outcomes of skin-reducing mastectomies, following PRISMA guidelines. Search terms included "cancer," "mastectomy," "mastopexy," and "nipple." We included studies detailing surgical techniques of nipple-preserving, skin-reducing mastectomy and its complications, excluding those with nipple grafting. Complications assessed were necrosis of the nipple-areola complex, infection, wound dehiscence, seroma, hematoma, fat necrosis, implant loss, and skin flap necrosis, analyzed using a random-effects model meta-analysis.

Twenty-eight studies included for data extraction. The review examined 1201 breasts from 716 patients who underwent skin-reducing mastectomy. Mean age was 47.45 ± 5.6 years. Mean BMI was 27.29 ± 2.45 kg/m 2 . Mean mastectomy weight was 633.78 ± 125.64 g. Mean implant size was 472.3 ± 125.67 cc. 45.87% of patients underwent SRM for therapeutic indications. 23.97% (CI = 17.40%, 31.15%) of all patients reported complications. The most common complication was necrosis of the nipple-areola complex (6.55%, CI = 3.84%, 9.78%). Reoperation rate for any complication was 6.76% (CI = 3.46%, 10.83%).

Systematic review and meta-analysis of outcomes for SRM demonstrates that nipple areolar necrosis is the most prevalent complication in this population. This finding underscores the necessity to examine various factors that may enhance outcomes for individuals in this cohort.