Nipple-sparing techniques can provide better outcomes for women undergoing breast reconstruction after mastectomy, but due to complication risks, these approaches are often not offered to women with sagging or larger breasts. For this group of patients, a “batwing” incision may provide a safer option for nipple-sparing mastectomy. These findings were reported in a study published by Kadakia et al in Plastic and Reconstructive Surgery.

"Our findings show that a simultaneous batwing mastopexy can be safely performed at the time of immediate breast reconstruction, while providing comparable complication rates and improving the aesthetic outcome," commented senior study author Hahns Y. Kim, MD, of Loma Linda University Medical Center.

Nipple-sparing procedures are an increasingly popular alternative for women undergoing mastectomy. In these techniques, the surgeon preserves the nipple and surrounding tissues for use in immediate breast reconstruction using implants. Preserving the nipple-areola complex allows for a more natural-looking reconstruction, leading to higher levels of patient satisfaction.

However, nipple-sparing mastectomy is generally not offered to women with ptosis of the breasts or larger breasts, reflecting concerns about suboptimal aesthetic outcomes and increased risk of complications. The batwing incision—so called because it consists of two semicircular incisions above the nipple, connected by angled "wings" on either side of the nipple-areola complex—enables the surgeon to perform a breast lift (mastopexy) at the same time as mastectomy.

Procedure Outcomes

Dr. Kim and colleagues reported their experience with batwing mastopexy for nipple-sparing mastectomy in 80 women. About half of patients were undergoing preventive mastectomy due to high genetic risk of breast cancer. Outcomes were compared to those of 244 patients undergoing standard implant-based reconstruction without preserving the nipple-areola complex. Women selected for batwing mastopexy had larger breasts and a greater degree of ptosis.

An average of 16 months after mastectomy and immediate reconstruction, the two groups of women had similar outcomes. At least one complication occurred in 23.8% of operated breasts in the batwing mastopexy group and 27.5% of the standard reconstruction group. Some minor complications, including hematoma and seroma, were less frequent in the batwing mastopexy group. Necrosis of the skin or nipple—a more serious complication—also occurred less frequently in the batwing mastopexy group: 6.3% vs 11.5% in the standard reconstruction group. The rate of revision surgery (including fat grafting to improve the aesthetic results) was lower after batwing mastopexy (23.7% vs 30.3%). Other factors such as obesity and smoking were risk factors for skin/nipple necrosis or major infections, but batwing mastopexy was not.

The researchers noted: "Complication rates in patients undergoing a simultaneous batwing mastopexy were comparable to those undergoing standard immediate implant-based reconstruction." Although the batwing technique is not new, the study provides new evidence that it may provide good aesthetic outcomes with no increase in complications in women with larger breasts or ptosis.

That's especially important, as it may allow surgeons to increase the number of patients who are offered nipple-sparing mastectomy for breast cancer treatment or prevention.

"A simultaneous batwing mastopexy may serve as an aesthetic enhancement for breast cancer patients undergoing immediate reconstruction," Dr. Kim and coauthors concluded. They emphasized the need for further studies to obtain higher-level evidence to help select patients who may benefit from this procedure.

Disclosure: For full disclosures of the study authors, visit journals.lww.com/plasreconsurg.