{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:06:41Z","timestamp":1758758801952,"version":"3.44.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Nipple-sparing mastectomy (NSM) with immediate implant-based reconstruction is widely accepted and effective prophylactic surgical approach for women with high-risk of hereditary BC. However, anatomical factors\u2014advanced breast ptosis and increased sternal notch-to-nipple (SN-N) distance\u2014can increase technical difficulty and complication risk. Preshaping procedures may optimize anatomy and broaden NSM eligibility. This study evaluates the role of preshaping in facilitating safe NSM with implant-based reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective analysis of 84 patients who underwent prophylactic mastectomy at Vilnius University Hospital Santaros Klinikos between 2018 and 2024. All had confirmed pathogenic mutations associated with hereditary BC risk. At the time of analysis, 76 patients had completed mastectomy, while 8 had undergone only the preshaping procedure. Patients were divided into two cohorts: single-stage NSM with direct-to-implant reconstruction, and a two-stage approach involving initial preshaping surgery followed by delayed NSM. Anatomical features, surgical timing, complications were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 76 patients, 63.2% underwent single-stage and 36.8% two-stage reconstruction. Two-stage patients had significantly greater SN-N distances (26.4\u2009\u00b1\u20093.1\u2005cm vs. 21.6\u2009\u00b1\u20093.2\u2005cm, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The overall complication rate was 7.9%, higher in the single-stage group (10.4%) than the two-stage group (3.6%). In the single-stage cohort, complications correlated with higher ptosis grades (<jats:italic>p<\/jats:italic>\u2009=\u20090.0021). Ductal carcinoma <jats:italic>in situ<\/jats:italic> was found in one patient from each group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Preshaping surgery effectively optimizes anatomy for NSM, reducing complications in patients with ptosis or extended SN-N distances. The two-stage approach offers safe and favorable outcomes in anatomically challenging cases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1651775","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:40:59Z","timestamp":1758692459000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of anatomical factors on surgical planning and outcomes in high-risk patients undergoing prophylactic mastectomy"],"prefix":"10.3389","volume":"12","author":[{"given":"Tomas","family":"Maciulaitis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiva","family":"Gudavicien\u0117","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nerijus","family":"Jakutis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/ajm.AJM_21_18","article-title":"Prophylactic mastectomy for the prevention of breast cancer: review of the literature","volume":"8","author":"Alaofi","year":"2018","journal-title":"Avicenna J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1159\/000485234","article-title":"Psychosocial aspects of immediate versus delayed breast reconstruction","volume":"12","author":"Heimes","year":"2017","journal-title":"Breast Care (Basel)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/PRS.0000000000003505","article-title":"Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction","volume":"140","author":"Bailey","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"B4","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":"B5","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1097\/GOX.0000000000000038","article-title":"Nipple sparing mastectomy: does breast morphological factor related to necrotic complications?","volume":"2","author":"Chirappapha","year":"2014","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B6","doi-asserted-by":"publisher","first-page":"864e","DOI":"10.1097\/PRS.0000000000010823","article-title":"Staged mastopexy before nipple-sparing mastectomy: improving safety and appearance in breast reconstruction","volume":"153","author":"Awaida","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1097\/PRS.0b013e3182865ad2","article-title":"Nipple-sparing mastectomy in patients with a history of reduction mammaplasty or mastopexy: how safe is it?","volume":"131","author":"Alperovich","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/PRS.0000000000003621","article-title":"Prophylactic nipple-sparing mastectomy and direct-to-implant reconstruction of the large and ptotic breast: is preshaping of the challenging breast a key to success?","volume":"140","author":"Gunnarsson","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e4767","DOI":"10.1097\/GOX.0000000000004767","article-title":"Expanding candidacy for nipple-sparing mastectomy in women with large or ptotic breasts: staged reconstruction outcomes","volume":"11","author":"Barnes","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.1093\/asj\/sjaa139","article-title":"Optimizing aesthetic outcomes in breast reconstruction after nipple-sparing mastectomy","volume":"40","author":"Frey","year":"2020","journal-title":"Aesthet Surg J"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1651775\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:40:59Z","timestamp":1758692459000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1651775\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":10,"alternative-id":["10.3389\/fsurg.2025.1651775"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1651775","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]},"article-number":"1651775"}}