Smile mastectomy, a new skin-reducing technique for patients to smile, again

Objectives. Skin-reducing mastectomy (SRM) is the best choice for patients with large and markedly ptotic breasts undergoing single-stage breast reconstruction with prosthesis. Wise-pattern skin-reducing mastectomy is the most common technique but it is burdened by a high incidence of wound healing problems. The objective of this work is to present an alternative direct-to-implant (DTI) approach to smile mastopexy with symmetrical SRM, and acellular dermal matrix (ADM)-assisted prepectoral breast reconstruction, capable of reducing recovery time and improving the overall therapeutic experience.
Methods. A prospective study of patients undergoing DTI breast reconstruction with our skin-reducing mastectomy technique, and prepectoral implant with a complete porcine ADM coating from January 2019, through October 2022 was undertaken. Enrolled patients had ptosis above grade 3 (Regnault classification) and breasts dimensions greater than D/E cups (European standard). Each patient signed the written informed consent document.
Results. We performed 20 procedures in 17 patients (3 bilateral, 14 unilateral). Seven patients had one-stage nipple-areola skin grafting (one bilaterally). Average hospital stay was 7,5 days. Six patients developed minor complications successfully treated with wound care or a simple procedure in outpatient settings, not resulting in reconstructive failure. Only one patient developed a major complication: an infection requiring implant replacement.
Conclusions. Even if the horizontal scar initially lays in a more visible place than the horizontal scar in Wise-pattern procedures, this is our DTI procedure of choice for patients with large/ptotic breasts that have to undergo SRM. We think this is a favourable compromise for a fast recovery and a reduced complications risk.