Extreme Nipple‐Sparing Mastectomy: Feasibility of Nipple Preservation and Immediate Reconstruction in Breasts Weighing Over 600 Grams in a Cohort of 43 Patients

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Background: Limited data exist on complication rates in nipple‐sparing mastectomy (NSM) in patients with large‐volume breasts. Our aim was to evaluate the early complication rates of NSM with immediate reconstruction in a consecutive cohort of patients with large‐volume breasts. Methods: After IRB approval, patients treated with prophylactic or therapeutic NSM and immediate reconstruction from January 2020 to June 2022 at our health network were identified. Patients with breast weights > 600 g (the extreme NSM group) were compared to patients with breast weights of 600 g or less (the average‐volume NSM group). Results: A total of 184 patients underwent NSM with immediate reconstruction. Forty‐three of 184 (23.37%) NSM patients had breast weights > 600 g. Of these, 30 patients had bilateral NSM, for a total of 73 breasts with volumes over 600 g, ranging from 603 to 1658 g. There were significantly more total complications in the extreme NSM compared to average‐volume NSM groups (41.86% vs. 21.99%, p = 0.009852). When broken down into major and minor complications, the extreme NSM group had significantly more major complications than the average‐volume NSM group (27.91% vs. 12.86%, p = 0.01072), but no difference in minor complications (13.95% vs. 9.29%, p = 0.2205). Overall, one (2.33%) patient in the extreme NSM group had a reconstruction failure, compared to three (2.14%) in the average‐volume NSM group. Only two of 43 (4.65%) patients in the extreme NSM group lost their nipples due to total or partial nipple necrosis. Conclusions: NSM with immediate reconstruction was successful in the majority of patients with large‐volume breasts. The rate of nipple loss was acceptably low. Women with breast volumes larger than 600 g who are motivated to save their nipples at the time of mastectomy could be offered NSM.

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