How I do It – Nipple Sparing Mastectomies for Large and Ptotic Breasts

Performing skin-reducing nipple-sparing mastectomy (SR-NSM) in patients with large and ptotic breasts remains one of the most demanding scenarios in breast surgery. Historically, these patients were considered poor candidates for NSM due to a higher risk of skin-flap ischemia, nipple–areola complex (NAC) necrosis, wound complications, and reconstructive failure.

With the expansion of indications for NSM, both in therapeutic breast cancer surgery and risk-reducing mastectomy, multiple surgical techniques have been developed to safely address excess skin, long nipple-to-inframammary fold distance, and compromised vascularity. These techniques differ in skin-reduction patterns, pedicle design, vascular preservation strategies, and reconstructive techniques, each offering specific advantages and limitations.

This webinar aims to provide a comparative and conceptual overview of different surgical approaches to SR-NSM in large and ptotic breasts, focusing on:
• the anatomical and vascular rationale behind each technique
• patient selection and risk stratification
• technical pearls and pitfalls
• short- and long-term outcomes including complications and aesthetic results

By critically analyzing and comparing available techniques, the webinar seeks to equip breast surgeons with the knowledge required to tailor the surgical strategy to individual patient anatomy and oncologic needs, thereby safely expanding NSM eligibility while preserving oncologic integrity and reconstructive success.