Outcomes of Nipple-Sparing Mastectomy in the Ptotic and Non-Ptotic Breast with Staged-Immediate Reconstruction Timing and Pre-Pectoral, Direct-to-Implant Technique

Background and objectives Proven to be oncologically safe, nipple-sparing mastectomy (NSM) preserves the entire breast skin envelope and is associated with higher patient satisfaction. However, breast ptosis is a relative contraindication to NSM, limiting who it is offered to. Direct-to-implant (DTI) breast reconstruction eliminates tissue expansion and shortens the reconstructive process but may be associated with mastectomy skin flap compromise after the placement of full-volume implants. Staged-immediate (SI) reconstruction initiates reconstruction two to three weeks after mastectomy. This timing and its use in DTI pre-pectoral (PP) breast reconstruction have not been reported. We aim to describe the outcomes of SI DTI PP reconstruction following NSM of ptotic and non-ptotic breasts. Methods Retrospective analysis utilizing descriptive statistics was completed evaluating patients who underwent nipple-sparing mastectomy with staged-immediate, pre-pectoral, direct-to-implant reconstruction by the senior author over a three-year period. Results and conclusions With SI timing, the majority of mastectomy-related problems occurred prior to implant placement, likely mitigating their effects on reconstruction following NSM, regardless of ptosis grade. Although a second procedure is needed for this reconstructive timing variation, over 50% of women achieved reconstruction completion at implant placement without further revision. These findings support the utility of SI timing in PP DTI reconstruction following NSM.