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“Hook Shape” Nipple-Sparing Mastectomy and Prepectoral Implant Reconstruction: Technique, Results and Outcomes from a Preliminary Case Series

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  • Breast Surgery
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Abstract

Introduction

Nipple-sparing mastectomy (NSM) is a surgical procedure increasingly performed for breast cancer or risk reduction surgeries. The site of skin incision seems to affect not only cosmesis but also technical ease in operating and vascular viability of the nipple. We present a series of patients who underwent a modified vertical surgical approach for NSM, which resulted to be safe, reliable, and with good esthetic results.

Materials and Methods

From December 2016 to February 2019, 27 “Hook Shape” incision NSMs were performed. All patients underwent an immediate subcutaneous muscle-sparing reconstruction with tissue expander covered by a titanium-coated polypropylene mesh, followed by a second surgical step with expander substitution and lipofilling on the definitive implant when indicated. Preoperative and postoperative BREAST-Q patient-reported outcomes measure was performed in all cases.

Results

Postoperative morbidity was evaluated: One patient developed seroma and another presented a systemic infection that resolved with intravenous infusion of antibiotics. One patient experienced vertical wound dehiscence, recovered after conservative treatment and without implant exposure. No implant loss was observed. Nipple–areola complex necrosis or ischemia rate was 0%. The BREAST-Q outcomes reported significant increases in the overall satisfaction with breast (p < 0.05), psychosocial well-being (p < 0.05), and sexual well-being (p < 0.05) sections. Scores in the physical impact of surgery section appeared to decline from preoperative to postoperative evaluations, with no statistically significant results.

Conclusion

The mastectomy incision pattern can burden the surgical challenge, impact vascular viability of the nipple and significantly affect the aesthetic outcomes in breast reconstruction. We report our experience with an alternative approach for NSM, which appears a safe, practical, and reproducible method for patients with small- to medium-sized breasts and little/medium ptosis (grade I or II).

Level of evidence IV

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Acknowledgement

We here acknowledge Miss Ottavia Cecchi, for her explanatory drawings of the technique.

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Authors and Affiliations

  1. Plastic and Reconstructive Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Marco Marcasciano & Manfredi Greco

  2. Unit of Plastic and Reconstructive Surgery, Department of Surgery, P. Valdoni Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Federico Lo Torto, Luca Codolini, Juste Kaciulyte & Diego Ribuffo

  3. Unit of Oncologic and Breast Surgery, A.O. Brotzu, Businco Oncologic Hospital, Cagliari, Italy

    Gianluigi Luridiana

  4. Department of Breast Cancer Surgery, UOC Chirurgia Oncologica Della Mammella, Azienda Ospedaliero-Universitaria Senese, University Hospital of Siena, Siena, Italy

    Dario Cassetti, Alessandro Neri & Donato Casella

  5. UOC Oncologia Chirurgica Ricostruttiva Della Mammella, Azienda USL Toscana Nord Ovest - Spedali Riuniti di Livorno, Livorno, Italy

    Leonardo Barellini

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  1. Marco Marcasciano
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Correspondence to Marco Marcasciano.

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Conflict of interest

Author Donato Casella has received a speaker honorarium from Pfm Medical, TiLOOP® Bra manufacturing company and is a member of Arista Breast Advisory Board for Becton Dickinson Italia S.p.a.. Author Dario Cassetti is a member of Arista Breast Advisory Board for Becton Dickinson Italia S.p.a.. The other authors declare that they have no conflicts of interest.

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Supplementary Information

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Video 1: video showing a breast expander wrapped by a preshaped titanium-coated polypropylene mesh. (MP4 93527 KB)

Video 2 Video showing step by step a monolateral “Hook Shape” Nipple-sparing mastectomy followed by a prepectoral breast reconstruction with breast expander wrapped by a pre-shaped titanium-coated polypropylene mesh. (MOV 1986 KB)

Video 3: bilateral “Hook Shape” NSM. This video shows dynamic aesthetic outcomes with the absence of animation deformity. (MPG 89830 KB)

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Marcasciano, M., Torto, F.L., Codolini, L. et al. “Hook Shape” Nipple-Sparing Mastectomy and Prepectoral Implant Reconstruction: Technique, Results and Outcomes from a Preliminary Case Series. Aesth Plast Surg 47, 546–556 (2023). https://doi.org/10.1007/s00266-022-03115-y

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