Staged Breast Reduction or Mastopexy before Nipple-Sparing Mastectomy: A Systematic Review and Meta-Analysis.

[BACKGROUND] Macromastia and breast ptosis have traditionally been considered to be relative contraindications to nipple-sparing mastectomy (NSM) because of concerns regarding nipple and mastectomy flap viability. Staged breast reduction or mastopexy before NSM has demonstrated promising results in decreasing these complications, although data are limited to single-center studies with small sample sizes.

[METHODS] A systematic review of PubMed, Scopus, and Cochrane databases was performed to identify all studies analyzing reconstructive outcomes in patients who underwent staged breast reduction or mastopexy before NSM. Descriptive analyses of surgical techniques and reconstructive outcomes were performed for relevant articles included for analysis. Random-effects model meta-analysis was performed to assess complication rates.

[RESULTS] Eleven studies, with a pooled total of 542 breasts (288 patients), were identified for analysis. The majority of mastectomies were performed prophylactically (79.2%). Staged breast reduction was performed in 75.2% of patients, and mastopexy was performed in 24.5%. The mean reduction weight per breast was 354.4 ± 64.0 g, and the mean mastectomy specimen weight was 527.5 ± 207.9 g. Autologous techniques were used for reconstruction in 39.7% of breasts, 59.6% had implant-based reconstruction, and 0.7% of cases had hybrid reconstruction. Meta-analysis demonstrated low rates of complications in patients who underwent staged NSM, including nipple-areola complex necrosis (3.1%; 95% CI, 0.8% to 6.3%) and mastectomy flap necrosis (2.4%; 95% CI, 0.1% to 6.3%).

[CONCLUSIONS] Systematic review and meta-analysis of outcomes for staged breast reduction or mastopexy demonstrate low rates of nipple and mastectomy flap necrosis. These data suggest thaprophylactic optimization of breast morphology can improve outcomes and expand candidacy for nipple-sparing procedures.