Preventing common shape deformities and complications in therapeutic mammoplasty: A practical guide

Therapeutic mammoplasty (TM) combines wide local excision with immediate volume displacement, enabling oncologically safe breast conservation while maintaining breast shape. Despite its benefits, postoperative complications and aesthetic deformities remain clinically relevant and may adversely affect patient satisfaction. Common sequelae include nipple-areola complex (NAC) malposition or necrosis, fat necrosis, bottoming-out, boxy breast contours, wound breakdown, and radiotherapy-associated fibrosis. This expert-opinion technical note draws on contemporary literature and operative experience from high-volume oncoplastic units to present practical strategies for preventing common deformities and complications in TM. Key considerations include preoperative planning and marking, vascular assessment, tension-minimising closure techniques and wound optimisation. By highlighting potentially modifiable technical factors, this article offers reproducible operative pearls that may help reduce selected preventable complications, improve aesthetic consistency, and support surgeons earlier in their learning curve. Prospective studies are needed to validate the impact of these strategies on clinical and patient-reported outcomes.