With ‘batwing’ mastopexy, more women can have a nipple-sparing mastectomy

Nipple-conserving techniques can provide better results for women undergoing breast reconstruction after a mastectomy—but because of the risks of complications, these approaches are often not offered to women with sagging or larger breasts. For this group of patients, a “batwing” incision may offer a safer option for nipple-sparing mastectomy (NSM), reports a study in the September issue of Plastic and Reconstructive Surgery.

“Our findings show that a simultaneous baton mastopexy can be safely performed at the time of immediate breast reconstruction, providing comparable complication rates and improving cosmetic outcome,” comments University ASPS Surgeon Hans Y. Kim, MD Loma Linda. .

Batwing mastectomy offers a safe approach to NSM in women with drooping or larger breasts

Nipple-conserving surgeries are an increasingly popular alternative for women undergoing mastectomies. In these techniques, the surgeon preserves the nipple and surrounding tissues (nipple-nipple complex or NAC) for use in immediate breast reconstruction using implants. Preservation of the NAC allows for a more natural-looking reconstruction, leading to higher patient satisfaction.

However, NSM is generally not offered to women with breast sagging (sagging) or larger breasts, reflecting concerns about suboptimal cosmetic results and increased risk of complications. The wing incision—so named because it consists of two semicircular incisions above the nipple, connected by angled “wings” on either side of the NAC—allows the surgeon to perform a breast lift (mastopexy) at the same time as the mastectomy.

Dr. Kim and colleagues report their experience with batwing mastopexy for NSM in 80 women. About half of the patients were undergoing prophylactic mastectomy because of a high genetic risk for breast cancer. Results were compared with those of 244 patients who underwent standard implant-based reconstruction without preservation of the NAC. Women selected for batwing mastopexy had larger breasts and a greater degree of droop.

Study participants

At an average of 16 months after mastectomy and immediate reconstruction, the two groups of women had similar outcomes. At least one complication occurred in 23.8% of operated breasts in the batwing mastopexy group and in 27.5% of the standard reconstruction group. Some minor complications, including hematoma (blood collections) and seroma (fluid collections), were less common in the batwing mastopexy group.

Necrosis (tissue death) of the skin or nipple—a more serious complication—was also less common in the batwing mastopexy group: 6.3% versus 11.5%. The rate of revision surgeries (including fat grafting to improve cosmetic results) was lower after batwing mastopexy (23.7% vs. 30.3%). Other factors such as obesity and smoking were risk factors for skin/nipple necrosis or major infections, but batwing mastopexy was not.

New evidence can improve patient outcomes

The study shows that “complication rates in patients who underwent simultaneous batwing mastopexy were comparable to those who underwent standard direct implant-based reconstruction,” the researchers write. Although the batwing technique is not new, the study provides new evidence that it can provide good cosmetic results without increasing complications in women with larger breasts or ptosis.

This is particularly important as it may allow surgeons to increase the number of patients offered NSM for the treatment or prevention of breast cancer. “A concurrent balloon mastopexy may serve as an aesthetic enhancement for breast cancer patients undergoing immediate reconstruction,” Dr. Kim and colleagues conclude. They emphasize the need for further studies to obtain higher-level evidence to help selected patients who may benefit from this procedure.