Summary
Introduction
Oncoplastic reconstruction can optimize breast conserving therapy. Nipple loss is
a concern in patients with significant ptosis and breast hypertrophy particularly
with pedicle undermining during tumor resection. The modified Robertson technique
(No-Vertical Scar reduction) has been previously described for breast reduction in
large, ptotic patients using a wide, bell-shaped inferior pedicle with only inframammary
fold and peri‑areolar incisions. The purpose of this study was to evaluate the No-Vertical
Scar (NVS) technique applied to oncoplastic reconstruction.
Methods
Women undergoing oncoplastic breast reduction using a NVS, Wise, or Vertical method
were assessed. Predictive variables included patient demographics, comorbidities,
and sternal notch to nipple (SNN) distance. Outcome variables were delayed wound healing,
surgical site infection, seroma, fat necrosis, nipple necrosis, use of a free nipple
graft, and time between surgery and adjuvant radiation.
Results
Fifty patients met inclusion criteria using NVS (N = 15), Wise (N = 16), and Vertical (N = 19) methods. The NVS group had a significantly higher BMI (p=.009), greater sternal notch to nipple distance (p=<0.001) and increased resection volume (p=<0.001) as compared to Wise and Vertical groups. There was no significant difference
in complications (p=.25). No nipple necrosis occurred, and no free nipple grafts were required.
Conclusion
The NVS approach is a useful technique for oncoplastic reconstruction in select patients
with macromastia and severe Grade II or Grade III ptosis. The wide, bell-shaped pedicle
is versatile for obliterating a lumpectomy cavity and optimizing nipple perfusion
if pedicle undermining occurs during resection.
Keywords
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Article info
Publication history
Published online: October 17, 2022
Accepted:
October 11,
2022
Received:
November 16,
2021
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
