A New Approach to Nipple-Sparing Mastectomy for Patients with Ptotic Breasts: A Single-Center, Retrospective Analysis of Feasibility and Treatment Outcomes

Background/Objectives: Subcutaneous mastectomies with immediate implant-based reconstruction have become widely performed procedures worldwide. Patients with small, non-ptotic breasts are candidates for procedures that do not involve skin reduction (NSM), whereas those with macromastia and significant ptosis undergo procedures involving the excision of excess skin (SRM). However, there remains a small group of patients for whom neither of these two options is ideal. We have developed a technique for reducing the implant pocket without excising excess skin, specifically designed for this group of patients. Methods: We conducted a retrospective analysis of 298 patients (419 breasts) who underwent surgery at our center between 2016 and 2025, comparing the method we described (NSM-LR) with NSM and SRM. A statistical analysis was performed. We evaluated oncological outcomes, complication rates, and implant loss. Satisfaction with the reconstructed breast was assessed using the Breast-Q questionnaire. Results: All cases were R0 resection. Locoregional recurrence was as follows: NSM—3.1%, NSM-LR—9.1%, and SRM—5.4% (p = 0.2363). Major complications were as follows: NSM—25.4%, NSM-LR—21.2%, and SRM—33.8% (p = 0.0887). Implant loss was as follows: NSM—7.6%, NSM-LR—10%, and SRM—17.6% (p = 0.0155). Breast Q score was as follows: NSM—78, NSM-LR—82, and SRM–75. Conclusions: NSM-LR can be a reasonable option for selected patients requiring a subcutaneous mastectomy.