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PURPOSE: Despite data supporting the oncologic safety of NSM, concerns still remain about the feasibility of NSM with immediate reconstruction in patients with large-volume breasts. Our aim was to evaluate the complication rate of these cases of "extreme NSM" (E-NSM) with immediate reconstruction. METHODS: Patients treated with prophylactic or therapeutic NSM with immediate reconstruction from 2020-2022 were identified. Cases represented the work 6 plastic surgeons and 7 breast surgeons, and all METHODS of reconstruction were included. Major and minor complications were evaluated for each patient, including seroma, hematoma, dehiscence, infection, skin/nipple/flap necrosis, capsular contracture, and implant displacement/extrusion/rupture. Major complications were those requiring return to OR. RESULTS: 41 patients (69 breasts) out of a total of 182 NSM patients had breast weights over 600g, ranging from 603g to 1658g. There was no significant difference in age, race, menopausal status, cancer stage, prior radiation, neoadjuvant chemotherapy, diabetic status, tobacco use, or reconstruction type between groups. E-NSM patients had higher mean BMI (31.1 vs 25.5, p < 0.05). Mean implant size for E-NSM was 416cc, and mean implant size for NSM was 250cc (p = 0.01). At a mean follow-up of 5.5 months, the percentage of major and minor complications in the E-NSM group was no different from NSM patients (p = 0.14). Only 2 patients in the E-NSM group experienced nipple necrosis. CONCLUSION: E-NSM presents an acceptably low rate of nipple necrosis and complication profile. Women with breast volumes larger than 600g can be safely offered NSM.
Moroni et al. (Wed,) studied this question.