Single-stage Free Nipple Grafting Mastopexy Reconstruction in 34 Patients With Long-term Clinical Follow-up

Summary:

Breast reconstruction for patients with pendulous breasts and grade III ptosis often requires multiple staged procedures, increasing perioperative risk and recovery burden. This case series presents a single-stage free nipple grafting (SFNG) mastopexy reconstruction technique that integrates multiple reconstructive steps into a single operation. From 2009 to 2019, 34 patients (68 breasts) underwent SFNG mastopexy reconstruction with follow-up through 2025. The average age of patients was 46 years, and the mean body mass index was 28.3 kg/m ² . All mastectomies were performed by a single breast surgeon, Heidi Rafferty, MD, providing consistency in oncological technique throughout the series. Immediate implant-based reconstruction was then performed by the author. Skin-reducing mastectomy patterns (Wise, vertical, or crescent incisions) were selected according to breast morphology. All reconstructions used submuscular implants supported by acellular dermal matrix, with immediate free nipple grafting to the newly positioned areola sites. Complications were limited to 3 cases of flap necrosis requiring revision, 3 episodes of cellulitis that resolved with intravenous antibiotics, and 9 seroma aspirations. Two patients received adjuvant radiation therapy without significant compromise of nipple graft viability. Long-term follow-up of up to 16 years revealed no local recurrences, minimal loss of nipple projection, and significant improvement in patient-reported outcomes. The BREAST-Q assessment demonstrated significant postoperative improvements in satisfaction, psychosocial well-being, and aesthetic outcomes. SFNG mastopexy reconstruction offers a reliable alternative for patients with grade III ptosis, combining oncological safety with immediate aesthetic restoration while reducing the need for multiple reconstructive procedures.