{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T08:43:54Z","timestamp":1776415434320,"version":"3.51.2"},"reference-count":32,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Polytech Health & Aesthetics"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Unilateral breast reconstruction in patients with Grade 2 ptosis presents significant challenges in achieving long-term symmetry. Traditional approaches require contralateral symmetrization, increasing operative time, costs, and the risk of postoperative asymmetry because of progressive changes in the contralateral breast. This study evaluated the effectiveness of the SIMPLE technique (Symmetry in Moderate Ptosis for Long-Lasting Effectiveness) in prepectoral direct-to-implant (DTI) breast reconstruction for patients with Grade 2 ptosis. The goal was to restore the breast's original shape and volume, avoiding contralateral procedures. A retrospective review of 23 patients undergoing nipple-sparing mastectomy (NSM) followed by DTI prepectoral reconstruction using polyurethane-coated implants (Polytech Microthane Sublime Line) was conducted. The median follow-up was 603 days (range, 349-826 days). Inclusion criteria included a BMI &amp;lt;35.5 and no previous radiotherapy. Intraoperative confirmation of skin flap viability was assessed through indocyanine green angiography. Implants were strategically positioned to maintain symmetry, with special attention to alignment and preserving natural contours. All patients reported high satisfaction without the need for secondary procedures. Four minor complications were observed, along with 2 infections that required implant removal. No significant postoperative complications, such as implant exposure in the lower pole, implant displacement, or significant breast asymmetry requiring implant changes, were observed during the follow-up period, highlighting the technique's safety and effectiveness. The SIMPLE technique may represent a reliable option for breast reconstruction in selected patients with Grade 2 ptosis, reducing the need for contralateral symmetrization, surgical complexity and potentially supporting more durable symmetry, favorable aesthetics, and patient satisfaction.<\/jats:p>\n                  <jats:p>Level of Evidence: 4 (Therapeutic)<\/jats:p>\n                  <jats:p\/>","DOI":"10.1093\/asjof\/ojaf173","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T12:26:42Z","timestamp":1767011202000},"source":"Crossref","is-referenced-by-count":0,"title":["The SIMPLE Technique for Unilateral Breast Reconstruction With Moderate Ptosis: Aiming for Durable Symmetry"],"prefix":"10.1093","volume":"8","author":[{"given":"Alessandro","family":"Quattrini Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Livio","family":"Colizzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Rossetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Coletti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Ghilli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Roncella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026041703423211200_ojaf173-B1","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1097\/PRS.0b013e3181bd05fd","article-title":"Nipple-sparing mastectomy and immediate tissue expander\/implant breast reconstruction","volume":"124","author":"Chen","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B2","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1097\/PRS.0b013e31822b6456","article-title":"Nipple-sparing mastectomy for prophylactic and therapeutic indications","volume":"128","author":"Spear","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B3","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1097\/PRS.0b013e3182a48b8a","article-title":"Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis","volume":"132","author":"Endara","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B4","doi-asserted-by":"publisher","first-page":"3241","DOI":"10.1245\/s10434-015-4739-1","article-title":"Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a metaanalysis and systematic review","volume":"22","author":"De La Cruz","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"2026041703423211200_ojaf173-B5","doi-asserted-by":"publisher","first-page":"184e","DOI":"10.1097\/PRS.0000000000002333","article-title":"\u201cBreast in a day\u201d: examining single-stage immediate, permanent implant reconstruction in nipple-sparing mastectomy","volume":"138","author":"Choi","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B6","doi-asserted-by":"publisher","first-page":"335e","DOI":"10.1097\/PRS.0000000000003027","article-title":"Outcome evaluation after 2023 nipple-sparing mastectomies: our experience","volume":"139","author":"De Vita","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B7","doi-asserted-by":"publisher","first-page":"S82","DOI":"10.1016\/j.breast.2017.06.034","article-title":"Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications","volume":"34","author":"Galimberti","year":"2017","journal-title":"Breast"},{"key":"2026041703423211200_ojaf173-B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/PRS.0b013e3182729cde","article-title":"A paradigm shift in U.S. breast reconstruction: increasing implant rates","volume":"131","author":"Albornoz","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B9","doi-asserted-by":"publisher","first-page":"7S","DOI":"10.1097\/PRS.0000000000003941","article-title":"Current trends in postmastectomy breast reconstruction","volume":"140","author":"Panchal","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B10","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/00006534-200208000-00013","article-title":"Nipple-areola reconstruction: satisfaction and clinical determinants","volume":"110","author":"Jabor","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B11","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.bjps.2011.09.023","article-title":"Nipple-areola complex sparing mastectomy with periareolar pexy for breast cancer patients with moderately ptotic breasts","volume":"65","author":"Rivolin","year":"2012","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026041703423211200_ojaf173-B12","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/PRS.0b013e3181ccdaa4","article-title":"Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study","volume":"125","author":"Djohan","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B13","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1097\/PRS.0b013e318241285c","article-title":"Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction","volume":"129","author":"Spear","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B14","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1097\/01.prs.0000438056.67375.75","article-title":"Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends","volume":"133","author":"Colwell","year":"2014","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B15","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1097\/PRS.0000000000001448","article-title":"Embrace the change: incorporating single-stage implant breast reconstruction into your practice","volume":"136","author":"Rodriguez-Feliz","year":"2015","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B16","doi-asserted-by":"publisher","first-page":"e754","DOI":"10.1016\/j.bjps.2010.06.002","article-title":"Nipple-sparing mastectomy in women with large or ptotic breasts","volume":"63","author":"Rusby","year":"2010","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026041703423211200_ojaf173-B17","doi-asserted-by":"publisher","first-page":"e2297","DOI":"10.1097\/GOX.0000000000002297","article-title":"Natural breast symmetry in preoperative breast cancer patients","volume":"7","author":"Cheong","year":"2019","journal-title":"Plast Reconstr Surg\u2014Glob Open"},{"key":"2026041703423211200_ojaf173-B18","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1007\/s00266-018-1082-5","article-title":"Analysis of symmetry stability following implant-based breast reconstruction and contralateral management in 582 patients with long-term outcomes","volume":"42","author":"Barone","year":"2018","journal-title":"Aesthetic Plast Surg"},{"key":"2026041703423211200_ojaf173-B19","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1007\/s00266-019-01489-0","article-title":"Breast asymmetry, classification, and algorithm of treatment: our experience","volume":"43","author":"de Vita","year":"2019","journal-title":"Aesthetic Plast Surg"},{"key":"2026041703423211200_ojaf173-B20","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1002\/pon.4586","article-title":"Body image dissatisfaction in patients undergoing breast reconstruction: examining the roles of breast symmetry and appearance investment","volume":"27","author":"Teo","year":"2018","journal-title":"Psychooncology"},{"key":"2026041703423211200_ojaf173-B21","doi-asserted-by":"publisher","first-page":"4305","DOI":"10.1245\/s10434-015-4434-2","article-title":"Systematic review: aesthetic assessment of breast reconstruction outcomes by healthcare professionals","volume":"22","author":"Maass","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"2026041703423211200_ojaf173-B22","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1245\/s10434-010-1368-6","article-title":"Assessment of cosmesis after breast reconstruction surgery: a systematic review","volume":"18","author":"Potter","year":"2011","journal-title":"Ann Surg Oncol"},{"key":"2026041703423211200_ojaf173-B23","doi-asserted-by":"publisher","first-page":"e1369","DOI":"10.1097\/GOX.0000000000001369","article-title":"Direct to implant reconstruction in nipple sparing mastectomy: patient selection by preoperative digital mammogram","volume":"5","author":"Rancati","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026041703423211200_ojaf173-B24","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.artmed.2007.02.007","article-title":"Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment","volume":"40","author":"Cardoso","year":"2007","journal-title":"Artif Intell Med"},{"key":"2026041703423211200_ojaf173-B25","doi-asserted-by":"publisher","first-page":"e1439","DOI":"10.1097\/GOX.0000000000001439","article-title":"Mastectomy flap thickness and complications in nipple-sparing mastectomy: objective evaluation using magnetic resonance imaging","volume":"5","author":"Frey","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026041703423211200_ojaf173-B26","doi-asserted-by":"publisher","first-page":"2663","DOI":"10.1007\/s00266-023-03729-w","article-title":"The role of the inframammary fold (IMF) in aesthetic and reconstructive surgery: a critical analysis and surgical solution","volume":"48","author":"Hudson","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"2026041703423211200_ojaf173-B27","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1097\/00006534-199809020-00018","article-title":"Focus on the breast fascial system: a new approach for inframammary fold reconstruction","volume":"102","author":"Nava","year":"1998","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B28","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1093\/asj\/sjad301","article-title":"One-stage implant-based breast reconstruction with polyurethane-coated device: standardized assessment of outcomes","volume":"44","author":"Catanuto","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026041703423211200_ojaf173-B29","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1055\/s-0038-1667365","article-title":"Impact of contralateral symmetry procedures on long-term patient-reported outcomes following unilateral prosthetic breast reconstruction","volume":"35","author":"Razdan","year":"2019","journal-title":"J Reconstr Microsurg"},{"key":"2026041703423211200_ojaf173-B30","doi-asserted-by":"publisher","first-page":"388e","DOI":"10.1097\/PRS.0000000000010317","article-title":"Histological and immunohistochemical evaluation of human breast capsules formed around five different expander surfaces","volume":"152","author":"Cagli","year":"2023","journal-title":"Plast Reconstr Surg"},{"key":"2026041703423211200_ojaf173-B31","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1093\/asj\/sjw183","article-title":"Polyurethane implants in 2-stage breast reconstruction: 9-year clinical experience","volume":"37","author":"Pompei","year":"2017","journal-title":"Aesthet Surg J"},{"key":"2026041703423211200_ojaf173-B32","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.breast.2020.09.009","article-title":"Immediate breast reconstruction after mastectomy with polyurethane implants versus textured implants: a retrospective study with focus on capsular contracture","volume":"54","author":"Loreti","year":"2020","journal-title":"Breast"}],"container-title":["Aesthetic Surgery Journal Open Forum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asjopenforum\/advance-article-pdf\/doi\/10.1093\/asjof\/ojaf173\/66150349\/ojaf173.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asjopenforum\/article-pdf\/doi\/10.1093\/asjof\/ojaf173\/68100045\/ojaf173.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asjopenforum\/article-pdf\/doi\/10.1093\/asjof\/ojaf173\/68100045\/ojaf173.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:42:41Z","timestamp":1776411761000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asjopenforum\/article\/doi\/10.1093\/asjof\/ojaf173\/8407132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":32,"URL":"https:\/\/doi.org\/10.1093\/asjof\/ojaf173","relation":{},"ISSN":["2631-4797"],"issn-type":[{"value":"2631-4797","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2025,12,30]]},"article-number":"ojaf173"}}