D38. Staged Mastopexy Prior to Nipple-sparing Mastectomy in Ptotic Breasts: A Multicenter Review and Timing Analysis

Abstract

PURPOSE: Nipple-sparing mastectomy (NSM) following mastopexy/breast reduction is increasingly utilized in patients with ptotic breasts to improve vascularity to the nipple-areolar complex (NAC) and decrease the risk of necrosis. This multi-center review and analysis aims to evaluate the safety, efficacy, and optimal timing. METHODS: PubMed, Scopus, and Web of Science were searched. We included all observational studies reporting complication outcomes and timing between staged NSM after breast reduction/mastopexy. We excluded studies that performed mastopexy after NSM, case reports, editorials and commentaries. RESULTS: Twelve studies meeting the eligibility criteria were included, with a combined sample of 552 breasts. The incidence of partial and complete NAC necrosis was 4.17% (23/552 breasts), while skin flap necrosis occurred in 2.72% (15/552 breasts). The average follow-up time was 14.55 months, and the average time interval between reduction or mastopexy and NSM was 9.35 months (range, 3 to 51.8 months). The number of included studies was not satisfactory for a reliable non-parametric correlation test. Instead, by means of ROC analysis, an interval of 4 months or longer was associated with lower odds of NAC necrosis (partial or complete; n = 12 studies, sensitivity 84.6%, specificity 44.4%). CONCLUSION: Although our analysis suggests that a 4-month interval or longer may minimize complications, further research with larger sample sizes and randomized controlled trials comparing staged and nonstaged approaches is necessary to establish definitive guidelines.