What is a staged breast cancer reconstruction with a reduction or lift?
When you have large breasts or droopy breasts (or both), you cannot have a breast cancer reconstruction that is nipple sparing. Why? Because a nipple sparing mastectomy for breast cancer preserves the nipple, but the skin is really thin. You cannot move the nipple at the same time without killing the nipple or the breast skin, so you couldn’t do a lift.
Nipple Sparing Mastectomy is an awesome surgery. Whether you are doing the mastectomy prophylactically (strong family history of breast cancer or BRCA positive), or you have breast cancer, when you do a mastectomy and preserve the nipple you tend to get better aesthetic outcomes.
Is it safe? Journal Review article
How safe is doing this surgery? It is known that women with large or droopy breasts have higher risks of complications and suboptimal aesthetic outcomes. To combat this, people started doing a two stage procedure. They “preshape” the breast by doing a lift or reduction first. They then let it heal, form a new blood supply to the nipple in its new position, and do the mastectomy months later. This is out of the Aesthetic Surgery Journal August 2025. “Staged Mastopexy or Mammaplasty Prior to Nipple Sparing Mastectomy: A Systematic Review of Safety and Nipple-Areola Complex Outcomes.”
Study:
- Systematic Review
- Looked at: surgical technique and complications including nipple necrosis, loss of mastectomy flap, infection, hematoma, and seroma
- 14 studies with 322 patients, 605 breasts were included
- Time between breast lift or breast reduction and mastectomy was 167 days.
- Complications were seen in 5.27% of cases, mostly minor infections
- Most of the mastectomies were not for cancer, they were prophylactic
They conclude, “these techniques enhance nipple position, reduce flap tension, and improve postoperative symmetry without significantly increasing complications.”
What do I think?
- I think for women who are droopy or have large breasts, doing a lift or breast reduction is great just to improve all the symptoms of large or droopy breasts- shouldner notching, back pain, neck pain, issues with breathing, issues with exercise, headaches, and more.
- Doing a breast reduction removes breast tissue. This lowers your risk of breast cancer (because you removed breast tissue), it gives a large sample of your tissue for pathology analysis, and it makes mammograms easier. Win. Win. Win.
- It makes a nipple sparing mastectomy possible. Without getting your nipple into the right place before a mastectomy, you cannot tighten, shape, or lift the breast at time of mastectomy. I consider it a little insurance in the bank if you need a mastectomy later.
I am a huge fan of breast reductions. I do the short scar, vertical lollipop technique. See my page on it.
Medical Reference
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
