Staged Reduction mammoplasty /prophylactic nipple-sparing mastectomy? (Full 32b, 11.25 bw, stg 1 ptosis, 40 yrs, no children)

I'm a candidate for NSM (stg 4 dense breasts, mother bc 2x) & would like to be smaller (full 32b to sm b). I want less projection (moderate implant) Can I do a staged reduction mammoplasty & then NSM? I understand insurance wouldn't cover the reduction, & am ok w/ paying. I've read studies about staging - mostly for d cup+ (ex: Dr. Scott Spears), but am not finding much before/afters w/ doctors who have done this. One option: Proceed w/ a reduction on my own and wait (a yr?) out for NSM?

Doctor Answers 6

Smaller size with mastectomy

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We have had much experience with NSM in patients who want smaller and more lifted appearing breasts. As the reconstructed breasts have more volume higher and across the base, this takes up a significant amount of the skin envelope so that the ptotic, droopy part is pulled up naturally.  That, coupled with the fact that some people have a surprising amount of elasticity and the skin retracts quite nicely in so many people, making skin removal unnecessary!  Only a few have so much redundancy that skin removal is necessary and can be done after the fact as well. No reason to create a scar or have an extra surgery if you can avoid it! 95% of the NSM surgery we perform at our center is direct to implant with an incision hidden at the bra line. Of course, seeing you and examining you in person would help tremendously with managing post op expectations. Good luck with your surgery!


Beverly Hills General Surgeon
5.0 out of 5 stars 2 reviews

Nipple sparing mastectomies

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I would need to examine you in person but I don't typically recommend a reduction in this scenario.  I would do a TE vs DTI based on the viability of the mastectomy skin flaps.

Staged reduction and NSM

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This is a good option for patients that would like to go smaller like yourself and not loose your nipple areola complex (NAC).  One year between procedures should be enough so that the NAC does not loose vascularity from the mastectomy, but this is a risk in these procedures that needs to be considered.  We have performed this procedure successfully in my practice.  

Nipple sparing mastectomy after a breast reduction

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It would be much easier to answer this question in person.  The difference between a full B and a small B is typically not that large, and you may be able to get this with an immediate implant reconstruction. 

It's best to seek an opinion from an experienced breast reconstrucdtion plastic surgeon to evaluate your options and your goals.

Roxanne Sylora, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast Reconstruction

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Agree, there is no need for staging and doing a reduction mammoplasty then a nipple sparing mastectomy.
an in person evaluation and discussion of your needs with the plastic surgeon and the breast surgeon. Evaluation of the skin, position of the nipple and the best method of reconstruction. Immediate to implant reconstruction if desired.

Samir Shureih, MD
Baltimore Plastic Surgeon

Staged Reduction mammoplasty /prophylactic nipple-sparing mastectomy? (Full 32b, 11.25 bw, stg 1 ptosis, 40 yrs, no children)

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If even considering NSM than why do a reduction? Plus you did not pot photos so can not advise. Best to seek ONLY in person opinions... 

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