High risk/preventative mastectomy: For breasts with significant ptosis what is the best technique for nipple sparing mastectomy?
Doctor Answers 3
Breast reconstruction if you have ptosis
Given the non-urgency, I would perform the best breast lift possible and heal: full anchor mastopexy with some reduction if necessary to help give you a lifted and tight breast. I would wait at least 3 to 6 months for the nipple sparing mastectomy (and I presume a single stage implant reconstruction).
Best of luck!
If your ptosis is not severe however, your tissue will shrink down a bit from the mastectomy itself and the nipple/areola position can be tacked up on the chest wall at the first stage during the mastectomy and tissue expander placement. Your result will look strange at first, but at stage 2 during the expander to implant exchange, excess skin can be removed to refine your shape. This can sometimes be done entirely via an incision in the fold beneath the breast. Finally, for the ultimate result, ask your surgeon about fat transfer to the breasts at stage 2 to create a result that completely mimics a cosmetic breast surgery.
On a final note, with regard to nipple viability with mastectomies, often the determining factor for success is the skill of the breast oncologic surgeon, not your plastic surgeon. It is the breast surgeon who has to be careful not to thin the tissue too much directly below the nipple and areola to ensure viability. Your best results will be obtained by choosing a center where the surgical breast oncologists work hand in hand with plastic surgeons on a daily basis. This team approach will yield both the best breast care and the best reconstructive success. Please reference the web link below for an example of this sort of team approach. Good luck!
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