Two-Stage Reconstruction of Large and Ptotic Breasts in Patients Undergoing Risk-Reducing Mastectomy: A Single Center Experience Using Autologous Tissue

In this study, we present cases of patients with large, ptotic breasts who underwent a two-stage reconstruction using a Wise-pattern reduction followed by mastectomy and autologous reconstruction. The aim of this study is to report our experience with a two-stage approach to risk-reducing mastectomy for ptotic breasts. We conducted a retrospective analysis of patients who underwent two-stage breast reconstruction between August 2019 and September 2023 at our institution. We included patients with large, ptotic breasts and excluded those who had undergone a previous cosmetic breast reduction and those lost to follow-up. We collected and analyzed data on patient demographics, operative details, and postoperative outcomes using descriptive statistics. A total of 61 patients underwent risk-reducing mastectomies, with five patients (8.19%) undergoing a two-stage reconstructive approach. The mean age of the study patients was 41.6 years, and they had an average body mass index of 29.16 kg/m2. All patients underwent a nipple-sacrificing mastectomy. Three patients received deep inferior epigastric artery perforator flaps, two received L-shaped upper gracilis (LUG) flaps, and one patient with a history of abdominal surgery underwent a LUG flap reconstruction. The average postoperative length of stay was 1.25 days following reduction and 2.8 days following reconstruction. The amount of tissue excised averaged 498.25 g for the right and 561.75 g for the left breast. The flap survival rate was 100%, with minimal complications. The results of our study emphasize the efficacy of our approach. We suggest additional comparative studies to refine the timing and techniques for optimal results.