Hinson Chandler, Sink Matthew, Buntic Rudolph F, Safa Bauback, Sammer Douglas, Zhang Andrew Y, Odobescu Andrei
Aesthet Surg J. 2025 Jul 15;45(8):807-813. doi: 10.1093/asj/sjaf058.
Patients with large or ptotic breasts undergoing nipple-sparing mastectomy (NSM) face reconstructive challenges, including higher risks of complications and suboptimal aesthetic outcomes. Preshaping procedures, such as mastopexy or reduction mammoplasty, have been proposed to optimize surgical outcomes by improving breast dimensions before NSM. This systematic review evaluates the safety and efficacy of these approaches. A comprehensive search of PubMed, Embase, Web of Science, and Cochrane identified studies involving preshaping mastopexy or reduction before NSM. Data on surgical technique and complications-including nipple-areola complex (NAC) necrosis, mastectomy flap necrosis, infection, hematoma, and seroma-were extracted and pooled. Fourteen studies with 322 patients and 605 breasts met inclusion criteria. The weighted mean interval between preshaping and NSM was 167 days. NAC complications occurred in 5.27% of cases, most commonly partial necrosis or superficial epidermolysis. Mastectomy flap complications were reported in 4.90%, and infection occurred in 9.29% of cases, primarily minor infections. Notably, the majority of included mastectomies were prophylactic, which may contribute to lower complication rates, as prophylactic cases generally carry a lower risk of nipple and skin flap necrosis than therapeutic ones. Overall, pooled complication rates were comparable with those in stand-alone mastopexy, reduction, or NSM procedures. Findings suggest that preshaping is a safe strategy that improves aesthetic and reconstructive outcomes in NSM for large or ptotic breasts. These techniques enhance NAC positioning, reduce flap tension, and improve postoperative symmetry without significantly increasing complications. This evidence supports the use of preshaping procedures in surgical planning for NSM. Level of Evidence: 2 (Therapeutic).
接受保留乳头的乳房切除术（NSM）的巨乳或下垂乳房患者面临重建挑战，包括更高的并发症风险和不理想的美学效果。已提出一些预塑形手术，如乳房上提术或乳房缩小成形术，以通过在NSM前改善乳房尺寸来优化手术效果。本系统评价评估了这些方法的安全性和有效性。通过全面检索PubMed、Embase、Web of Science和Cochrane数据库，确定了涉及NSM前预塑形乳房上提术或乳房缩小术的研究。提取并汇总了有关手术技术和并发症的数据，包括乳头乳晕复合体（NAC）坏死、乳房切除皮瓣坏死、感染、血肿和血清肿。14项研究共纳入322例患者和605个乳房，符合纳入标准。预塑形与NSM之间的加权平均间隔为167天。NAC并发症发生率为5.27%，最常见的是部分坏死或表皮浅层松解。乳房切除皮瓣并发症报告发生率为4.90%，感染发生率为9.29%，主要为轻度感染。值得注意的是，纳入的大多数乳房切除术是预防性的，这可能是并发症发生率较低的原因，因为预防性病例通常比治疗性病例发生乳头和皮瓣坏死的风险更低。总体而言，汇总的并发症发生率与单独进行乳房上提术、乳房缩小术或NSM手术的发生率相当。研究结果表明，预塑形是一种安全的策略，可改善NSM治疗巨乳或下垂乳房的美学和重建效果。这些技术可改善NAC定位，降低皮瓣张力，改善术后对称性，且不会显著增加并发症。这一证据支持在NSM手术规划中使用预塑形手术。证据级别：2（治疗性）。
