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Staged Nipple-Sparing Mastectomy for Patients with Large or Ptotic Breasts

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Oncoplastic Breast Surgery Techniques for the General Surgeon

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Abstract

Historically, nipple-sparing mastectomy (NSM) has been limited by both oncologic and anatomic considerations. From an oncologic standpoint, NSM was offered to women with smaller peripheral tumors with clinically negative nodes. Anatomically, NSM was contraindicated in women with breasts that were excessively large or ptotic (Baker Grade II or III ptosis). To overcome these anatomic limitations in larger, ptotic breasts, a staged nipple-sparing mastectomy following mastopexy or reduction mammoplasty was first described in 2011 to expand the indications for NSM. Early results were encumbered by wound healing complications due to a short interval between stages. Since that time, treatment algorithms and techniques have been improved to enhance oncologic safety and improve wound healing complications. Women are offered a nipple-repositioning procedure (i.e., mastopexy or reduction mammoplasty) combined with a lumpectomy during the initial stage. They are then allowed to achieve full tissue healing for 10–12 weeks before undergoing definitive NSM. This allows women only with large, ptotic breasts to pursue NSM without sacrificing the tissue viability of the nipple-areola complex.

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Author information

Authors and Affiliations

  1. Peterson Chair of Breast Cancer Research, Inova Schar Cancer Institute, Inova Fairfax Hospital, Fairfax, VA, USA

    Shawna C. Willey

  2. Private Practice, Washington, DC, USA

    Troy A. Pittman & James M. Economides

  3. Private Practice, Arlington, VA, USA

    James M. Economides

Authors
  1. Shawna C. Willey
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  2. Troy A. Pittman
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  3. James M. Economides
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Editor information

Editors and Affiliations

  1. University of Texas Medical Branch, Galveston, TX, USA

    V. Suzanne Klimberg

  2. Breast Surgery, Guy’s and St. Thomas’ Hospital, King’s College London Guy’s and St. Thomas’ Hospital, London, UK

    Tibor Kovacs

  3. Clinica Universidad de Navarra, Universidad de Navarra, Madrid, Spain

    Isabel T. Rubio

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Willey, S.C., Pittman, T.A., Economides, J.M. (2020). Staged Nipple-Sparing Mastectomy for Patients with Large or Ptotic Breasts. In: Klimberg, V., Kovacs, T., Rubio, I. (eds) Oncoplastic Breast Surgery Techniques for the General Surgeon. Springer, Cham. https://doi.org/10.1007/978-3-030-40196-2_21

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  • DOI: https://doi.org/10.1007/978-3-030-40196-2_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-40195-5

  • Online ISBN: 978-3-030-40196-2

  • eBook Packages: MedicineMedicine (R0)

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