The SIMPLE Technique for Unilateral Breast Reconstruction With Moderate Ptosis: Aiming for Durable Symmetry

Unilateral breast reconstruction in patients with Grade 2 ptosis presents significant challenges in achieving long-term symmetry. Traditional approaches require contralateral symmetrization, increasing operative time, costs, and the risk of postoperative asymmetry because of progressive changes in the contralateral breast. This study evaluated the effectiveness of the SIMPLE technique (Symmetry in Moderate Ptosis for Long-Lasting Effectiveness) in prepectoral direct-to-implant (DTI) breast reconstruction for patients with Grade 2 ptosis. The goal was to restore the breast's original shape and volume, avoiding contralateral procedures. A retrospective review of 23 patients undergoing nipple-sparing mastectomy (NSM) followed by DTI prepectoral reconstruction using polyurethane-coated implants (Polytech Microthane Sublime Line) was conducted. The median follow-up was 603 days (range, 349-826 days). Inclusion criteria included a BMI <35.5 and no previous radiotherapy. Intraoperative confirmation of skin flap viability was assessed through indocyanine green angiography. Implants were strategically positioned to maintain symmetry, with special attention to alignment and preserving natural contours. All patients reported high satisfaction without the need for secondary procedures. Four minor complications were observed, along with 2 infections that required implant removal. No significant postoperative complications, such as implant exposure in the lower pole, implant displacement, or significant breast asymmetry requiring implant changes, were observed during the follow-up period, highlighting the technique's safety and effectiveness. The SIMPLE technique may represent a reliable option for breast reconstruction in selected patients with Grade 2 ptosis, reducing the need for contralateral symmetrization, surgical complexity and potentially supporting more durable symmetry, favorable aesthetics, and patient satisfaction. Level of Evidence: 4 (Therapeutic).