More breast cancer patients, particularly women with large or sagging breasts who previously did not qualify for certain surgeries, are now candidates for the most complex nipple sparing breast reconstructive surgery using the body’s own tissue. According to a new study published in the journal Plastic and Reconstructive Surgery by world renowned surgeons Craig Blum, MD, FACS, Frank J. DellaCroce, MD, FACS; Scott K. Sullivan, MD, FACS; Alan Stolier MD, FACS; Chris Trahan, MD, FACS; and M. Whitten Wise, MD, from the Center for Restorative Breast Surgery.
Women with large or sagging breasts are often not offered preservation of their nipple complex due to the inability to elevate the nipple position after mastectomy. The findings in the peer-reviewed journal present compelling evidence that perforator flap reconstruction is often better than implant reconstruction for women undergoing nipple sparing mastectomy (NSM). Surgeons at the Center for Restorative Breast Surgery have now pioneered a stunning technology that completely overcomes limitations, allowing more breast cancer patients to take advantage of the surgery. In the article entitled “Nipple Sparing Mastectomy and Ptosis: Perforator Flap Breast Reconstruction Allows Full Secondary Mastopexy with Complete Nipple Areolar Repositioning,” Dr. DellaCroce and his team describe the technique that, for the first time, allows for a full breast lift or breast reduction after nipple sparing mastectomy. The technology that makes this possible means that women who were previously denied preservation of their nipple at the time of mastectomy no longer have to be excluded due to pre-existing poor nipple position or breast size. This advancement has the capacity to produce results that were previously unachievable with better breast appearance after mastectomy than before.
The American Society of Plastic Surgeons selected this article as one of the three studies highlighted in a video feature presented on the ASPS website showcasing the article as an informative, clinical, and applicable evidence-based study showing the power of peer reviewed plastic surgery science and clinical research.
“Implant reconstructions outweigh natural tissue reconstruction by nearly 5 times in the U.S., and some of that is because we don’t do a good enough job of informing women of what is possible with living fat transplant procedures,” states Dr. DellaCroce, lead author and one of the founders of The Center for Restorative Breast Surgery. “It is essential that women know about this advancement before being talked into cutting away their nipples to tighten the extra skin over an implant-based procedure. No-one thought this was possible before now, and the importance of this discovery cannot be overstated. As nipple sparing mastectomy becomes more common, we can now offer the same extraordinary outcomes to women with drooping breasts or those with very large breasts. These women, who were previously denied nipple sparing mastectomy due to poor nipple position, can now have a full breast lift or reduction as a part of their overall surgery while still protecting their natural nipple. The key point that women must understand, is that this is impossible to accomplish with an implant reconstruction, but completely possible with a microsurgical flap reconstruction.”
“Through our vast experience with NSM and simultaneous perforator flap breast reconstruction, we have discovered that the growth of new blood supply into the nipple from the power of the underlying flap is adequate to fully support it for a breast lift. The purpose of reviewing these data, compiled from two and a half years of work, was to prove the hypothesis that the nipple position could be shifted, based solely on vascular contributions from the underlying perforator flap and that a full breast remodeling and lift could be accomplished without necrosis of the nipple. This allows tremendous freedom in the shaping of the breast and nipple height positioning.” The technique for secondary mastopexy (breast lift) after NSM and immediate perforator flap reconstruction is subsequently described and the surgeons’ experience with an associated 116 NSMs in 70 patients is reviewed. The results revealed that all patients enjoyed high levels of satisfaction with their ultimate outcomes. Subsequently, a 100% success rate was reported in terms of nipple areaolar complex survival, and patients who underwent the procedure benefitted from improvement in nipple position, breast shape, and their degree of ptosis.
The journal article concludes that there is a significant potential advantage of flap-based breast reconstruction over implant reconstruction in women who may benefit from a breast lift or breast reduction, and who also desire nipple-sparing mastectomy.