Secondary Mastopexy in the Reconstructed Ptotic Breast: Insights on Nipple Areolar Preservation and Complications
Osama Darras, Kate Jensen, Diwakar Phuyal, Raffi Gurunian, Sarah N. BishopABSTRACT
Introduction
Secondary mastopexy is frequently performed following nipple‐sparing mastectomy (NSM) with deep inferior epigastric perforator (DIEP) flap breast reconstruction to address ptosis and optimize aesthetic outcomes. Preservation of the nipple–areolar complex (NAC) during secondary mastopexy remains a concern, particularly in ptotic breasts. This study aims to describe a single surgeon's experience with secondary mastopexy and to examine factors that may impact complication rates.
Methods
This retrospective institutional review examines patients with grade 2 or 3 ptosis who received secondary mastopexy following NSM with immediate or delayed DIEP flap reconstruction. All patients underwent peri‐areolar incision design with preservation of an inferior dermal pedicle, and operative perfusion assessment was performed primarily with indocyanine green (ICG). Complications were recorded and grouped as minor or major events. Exploratory breast‐level comparisons were performed for selected risk factors.
Results
Eleven patients with 21 breasts were included. Mastectomy incisions included L‐shaped ( n = 9), inframammary ( n = 10), and Wise pattern ( n = 2) incisions. Ten of the eleven patients underwent delayed reconstruction. Five breasts received radiation before mastopexy. Complications occurred in nine breasts, most commonly minor wound dehiscence ( n = 4) and NAC epidermolysis/discoloration ( n = 2). No cases of full‐thickness NAC necrosis occurred. In exploratory analysis, complications were more frequent after therapeutic than prophylactic NSM per patient (7/8 [87.5%] vs. 0/3 [0%], p = 0.02). However, this correlation was not significant at the breast level (5/8 [62.5%] vs. 4/13 [30.8], p = 0.20). Prior radiation showed a borderline association with complications per patient (5/5 [100%] vs. 2/6 [33.3%], p = 0.06). However, this correlation was not significant at the breast level (2/5 [40.0%] vs. 6/15 [40.0], p = 1.00).
Conclusion
Nipple‐preserving secondary mastopexy following NSM and DIEP flap reconstruction is supported in selected patients, with preservation of NAC viability and no observed cases of necrosis in this series. Larger, multi‐institutional studies are needed to better define patient selection, timing, and the effect of prior oncologic treatment on outcomes.