{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T04:55:00Z","timestamp":1794632100669,"version":"4.9.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Despite advances in skin envelope reduction techniques and experienced nipple-sparing mastectomy flap procedures, the rate of nipple malposition and secondary revision in these patients remains high and eligible candidates are limited. In this article, the authors present a novel technique combining skin reduction nipple-sparing mastectomy surgery with single-stage skin-only mastopexy and direct-to-implant reconstruction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A retrospective review was performed at a single institution from 2015 to 2018. All patients were operated on using this technique consecutively, by a breast and plastic surgeon team (A.F. and A.M.). Surgical technique and outcomes were compared with the currently accepted literature.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Twenty-six patients (40 breasts) underwent this technique; all were single-stage direct-to-implant reconstructions. The average body mass index was 31 kg\/m<jats:sup>2<\/jats:sup>. A Wise pattern was used in 35 breasts (87.5 percent) and prepectoral placement was used in 25 breasts (62.5 percent). Overall complications included seroma [<jats:italic toggle=\"yes\">n<\/jats:italic> = 6 (15 percent)], vertical\/T-junction dehiscence [<jats:italic toggle=\"yes\">n<\/jats:italic> = 4 (10 percent)], skin necrosis [<jats:italic toggle=\"yes\">n<\/jats:italic> = 4 (10 percent)], superficial or partial nipple necrosis [<jats:italic toggle=\"yes\">n<\/jats:italic> = 4 (10 percent)], with no total nipple-areola complex lost and no reconstructive failures at 18.7 months\u2019 average follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In this article, the authors share a novel reconstructive technique in which the skin envelope is reduced, the nipple-areola complex is repositioned, and a direct-to-implant reconstruction is performed in a single stage at the time of mastectomy. Consideration of pearls and pitfalls accompanies a review of the authors\u2019 experienced complication profile, and is discussed in the context of current literature.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CLINICAL QUESTION\/LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Therapeutic, IV.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/prs.0000000000007485","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T18:55:23Z","timestamp":1608749723000},"page":"38-45","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":19,"title":["Pushing the Envelope: Skin-Only Mastopexy in Single-Stage Nipple-Sparing Mastectomy with Direct-to-Implant Breast Reconstruction"],"prefix":"10.1097","volume":"147","author":[{"given":"Rachel E.","family":"Aliotta","sequence":"first","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isis","family":"Scomacao","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliana F. R.","family":"Duraes","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz J.","family":"Kwiecien","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D.","family":"Durand","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Fanning","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Moreira","sequence":"additional","affiliation":[{"name":"From the Department of Plastic and Reconstructive Surgery and the Division of Surgical Oncology and Breast Services, Cleveland Clinic; and Cereaga Plastic Surgery (private practice)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,12,24]]},"reference":[{"key":"R1-20250501","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1097\/PRS.0b013e31822b6456","article-title":"Nipple-sparing mastectomy for prophylactic and therapeutic 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