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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Pre-Pectoral Polyurethane Implant Reconstruction Following Batwing Skin-Reducing Mastectomy: A Single-Center Study.

Alessandra Veronesi1, Edoardo Caimi2, Gianmaria Ceglia2

  • 1IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.

Journal of Clinical Medicine
|May 4, 2026
PubMed
Summary

Batwing skin-reducing mastectomy with immediate pre-pectoral implant reconstruction offers a safe solution for patients with large or ptotic breasts, improving outcomes and patient satisfaction.

Keywords:
batwing mastectomybreast cancerbreast reconstructiondirect-to-implantimplant-based breast reconstructionskin-reducing mastectomy

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Area of Science:

  • Plastic Surgery
  • Breast Reconstruction
  • Oncologic Surgery

Background:

  • Pre-pectoral direct-to-implant breast reconstruction is gaining popularity due to reduced pain and avoidance of major muscle dissection.
  • Reconstruction challenges persist in patients with large or ptotic breasts, particularly concerning skin envelope, nipple viability, and implant stability.

Purpose of the Study:

  • To evaluate the safety and efficacy of batwing skin-reducing mastectomy combined with immediate pre-pectoral polyurethane-coated implant reconstruction.
  • To assess complication rates and patient-reported outcomes in this specific patient cohort.

Main Methods:

  • Retrospective single-center study of patients undergoing batwing skin-reducing mastectomy and immediate pre-pectoral implant reconstruction.
  • Data collection included demographics, oncologic details, operative parameters, postoperative events, and BREAST-Q scores.
  • Primary outcomes focused on complications, oncologic events, and 12-month patient-reported outcomes.

Main Results:

  • The study included 13 patients (18 breasts) with a mean follow-up of 12.85 months; mean ptosis grade was 3.46.
  • No seromas or oncologic recurrences were observed. Complications included one hematoma and one late infection requiring implant removal.
  • Superficial nipple-areola complex epidermolysis occurred in four patients but resolved conservatively; no full-thickness necrosis was noted.

Conclusions:

  • Batwing skin-reducing mastectomy with immediate pre-pectoral implant reconstruction is a safe and reproducible technique for selected patients with advanced breast ptosis.
  • The procedure demonstrates acceptable complication rates and leads to significant improvements in patient-reported outcomes, including satisfaction and well-being.