Single-Stage Nipple Sparing Mastectomy with Concurrent Mastopexy: A Systematic Review and Meta-Analysis

Patients with macromastia or breast ptosis are typically considered poor candidates for nipple-sparing mastectomy (NSM) due to concerns regarding nipple and mastectomy flap vascularity as well as challenges in maintaining optimal nipple position due to the redundant skin envelope. Several techniques for concurrent NSM and mastopexy have been described with encouraging results; however, data is limited to case series with small sample sizes. PubMed, Scopus, and Cochrane databases were queried to identify all studies analyzing outcomes in patients who underwent nipple-sparing mastectomy and simultaneous mastopexy with implant-based reconstruction. Study characteristics, patient demographics, surgical techniques, and post-operative complications were collected from relevant articles. Random-effects model meta-analysis was performed to assess complication rates. Nineteen studies, with a pooled total of 1,076 breasts were identified for analysis. The average patient was 48.1 ± 5.2 years old with a mean BMI of 27.2 ± 3.0 and a mean mastectomy specimen weight of 701.3 ± 93.8 g. The majority of mastopexies were performed using a Wise-pattern skin resection (70%) however there was a wide variety of dermal pedicles used to supply the nipple-areolar complex (NAC). Meta-analysis demonstrated acceptable complication rates, including partial NAC necrosis (5.9%, CI 3.0-9.5 %), total NAC necrosis (0.9%, CI 0.0-2.4%), and mastectomy flap necrosis (3.1%, CI 0.7-6.6%). The current literature supports the safety of performing single-stage NSM and mastopexy in favorable and highly selective patient populations. Additional studies are needed to refine specific, objective preoperative and intraoperative indications as well as to evaluate aesthetic and patient-reported outcomes.