Nipple-Sparing Skin-Reducing Mastectomy and Immediate Prepectoral Breast Reconstruction: A New Surgical Approach

Abstract Background Nipple-sparing mastectomy in medium-large, ptotic breasts presents challenges because of redundant skin and risks to the nipple–areola complex (NAC). Advances in skin-reducing techniques and immediate prepectoral reconstruction aim to improve both oncological safety and aesthetic outcomes. Objectives The authors of this study present a novel surgical approach designed to enhance NAC vascularization by performing a nipple-sparing skin-reducing mastectomy exclusively through the lower lateral triangle of a Wise-pattern incision with immediate prepectoral polyurethane-coated breast implant (Microthane, POLYTECH, Dieburg, Germany) reconstruction. This approach seeks to minimize implant exposure risks by limiting the scar laterally, thus optimizing breast contour and patient satisfaction. Methods A prospective analysis of 10 patients undergoing monolateral procedures was conducted between April and August 2023. Inclusion criteria included Grade 2 ptosis with an expected nipple repositioning of ≤8 cm. The technique preserved vascular connections through precise de-epithelialization and assessed intraoperative flap perfusion. Implant selection ensured symmetry. Postoperative outcomes were evaluated using the BREAST-Q questionnaire and routine follow-ups (18 months). Associations between BREAST-Q scores and patient characteristics were analyzed through Pearson correlation and analysis of variance. Results Mean patient age was 52 years, BMI 24 kg/m2, and implant volume 328 cc. Complication rates were low, with no cases of capsular contracture or implant displacement. BREAST-Q scores demonstrated high satisfaction, and a significant positive correlation was found between BMI and physical well-being (P = .03). Conclusions This single-stage technique for immediate prepectoral breast reconstruction in ptotic breasts may be safe and provide good aesthetic and functional outcomes. Further studies with extended follow-up and greater numbers are warranted. Level of Evidence: 4 (Therapeutic)