The Use Of Perforator Flaps Allow The Use Of Breast Lift Following Nipple-sparing Mastectomy


Previously, patients with moderate to severe breast ptosis (drooping) were not considered good candidates for nipple-sparing mastectomy. Dr. DellaCroce and our team of surgeons conducted a revolutionary study that contradicts this. They concluded that the perforator flap reconstruction technique allows patients with severe ptosis to undergo both nipple repositioning and a breast lift, preserving their nipples in the process.

Droopy breasts are also known as ptotic. Women with droopy breasts, or with moderate to severe ptosis are considered by many to be poor candidates for nipple-sparing mastectomy. These women are thought to be at an increased risk of nipple loss (necrosis) and to have an impaired ability to reposition the nipple at an appropriate location. One strategy, previously reported is to perform a staged procedure in patients who are undergoing nipple sparing mastectomy for risk reduction. In this situation, a reduction or lift is carried out prior to mastectomy and then a nipple sparing mastectomy is carried out several months later. This is an excellent strategy but is not appropriate for those women who have been recently diagnosed with breast cancer. The reconstructive surgeons at the Center for Restorative Breast Surgery (CRBS) in New Orleans have applied a different and unique approach. They theorized that the nipple-areola complex could be repositioned with a breast lift based entirely on new blood vessels that originated from the underlying tissue reconstruction. When silicone gel or saline implants are used for reconstruction, no new blood vessels are formed and movement of the nipple-areola complex would result in complete necrosis (tissue loss).

In a recent study published in the prestigious Journal of Plastic and Reconstructive Surgery, the reconstruction surgeons at CRBS, studied 70 women who underwent 116 nipple-sparing mastectomies. Immediate reconstruction was performed with a DIEP (abdominal tissue) and 62 patients and a SGAP (buttock tissue) in 54 patients. Small areas of skin loss occurred in patients which all healed after appropriate wound care. There were no tissue flap failures. An example of a woman who underwent reconstruction followed by a breast lift (masteopexy) can be seen in the accompanying photo. This type of surgery would not have been possible had an implant been used for reconstruction at the original surgery.

To paraphrase the authors of the paper, it is now possible to safely create a full thickness complete incision around the nipple areola complex (making a breast lift possible) and still preserve the nipple areola complex without necrosis. This exists because of robust nipple vascular supply coming from the underlying tissue reconstruction. The authors further noted that this removes any contraindication even in advance ptosis or droopy breasts, from the selection criteria in patients who desire to have a nipple sparing mastectomy who have been diagnosed with breast cancer.