Newswise — August 31, 2022 – Nipple-conserving techniques can provide better results for women undergoing breast reconstruction after mastectomy – but due to risks of complications, these approaches are often not offered to women with sagging or larger breasts. For this group of patients, a “batwing” incision may offer a safer option for nipple-sparing mastectomy (NSM), reports a study in the September issue of Plastic and Reconstructive Surgery®, its official medical journal American Society of Plastic Surgeons (ASPS). Plastic and Reconstructive Surgery® published in the Lippincott portfolio by Wolters Kluwer.
“Our findings show that a simultaneous balloon mastopexy can be safely performed at the time of immediate breast reconstruction, providing comparable complication rates and improving cosmetic outcome,” comments Surgeon Hahns Y. Kim, ASPS, Loma Linda University Medical Center.
Batwing mastectomy offers a safe approach to NSM in women with drooping or larger breasts
Nipple-conserving surgeries are an increasingly popular alternative for women undergoing mastectomies. In these techniques, the surgeon preserves the nipple and surrounding tissues (nipple-nipple complex or NAC) for use in immediate breast reconstruction using implants. Preservation of the NAC allows for a more natural-looking reconstruction, leading to higher patient satisfaction.
However, NSM is generally not offered to women with breast sagging (sagging) or larger breasts, reflecting concerns about suboptimal aesthetic results and increased risk of complications. The batwing incision—so named because it consists of two semicircular incisions above the nipple, connected by angled “wings” on either side of the NAC—allows the surgeon to perform breast lift (mastopexy) at the same time as the mastectomy.
Dr. Kim et al report their experience with batwing mastopexy for NSM in 80 women. About half of the patients were undergoing prophylactic mastectomy because of a high genetic risk for breast cancer. The results were compared with those of 244 patients who underwent standard implant-based reconstruction without preservation of the NAC. Women selected for batwing mastopexy had larger breasts and a greater degree of droop.
Study participants
At an average of 16 months after mastectomy and immediate reconstruction, the two groups of women had similar outcomes. At least one complication occurred in 23.8% of operated breasts in the batwing mastopexy group and in 27.5% of the standard reconstruction group. Some minor complications, including hematoma (blood collections) and seroma (fluid collections), were less common in the batwing mastopexy group.
Necrosis (tissue death) of the skin or nipple – a more serious complication – was also less common in the batwing mastopexy group: 6.3% versus 11.5%. The rate of revision surgery (including fat grafting to improve cosmetic results) was lower after batwing mastopexy (23.7% vs. 30.3%). Other factors such as obesity and smoking were risk factors for skin/nipple necrosis or major infections, but batwing mastopexy was not.
New evidence can improve patient outcomes
The study shows that “complication rates in patients who underwent simultaneous batwing mastopexy were comparable to those who underwent standard direct implant-based reconstruction,” the researchers write. Although the batwing technique is not new, the study provides new evidence that it can provide good cosmetic results without increasing complications in women with larger breasts or ptosis.
This is particularly important as it may allow surgeons to increase the number of patients offered NSM for the treatment or prevention of breast cancer. “A concurrent balloon mastopexy may serve as an aesthetic enhancement for breast cancer patients undergoing immediate reconstruction,” Dr. Kim and colleagues conclude. They emphasize the need for further studies to obtain higher-level evidence to help selected patients who may benefit from this procedure.
DOI: 10.1097/PRS.0000000000009380
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For Plastic and Reconstructive Surgery
For more than 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for any specialist using plastic surgery techniques or working in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-date reports on the latest techniques and follow-up on all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn reconstruction and cosmetic surgery, as well as news on medico-legal issues.
About ASPS
THE American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the company is recognized as a leading authority and source of information on cosmetic and reconstructive plastic surgery. The ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the company represents physicians certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
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