In this video-based CME activity, Arthur Salibian, MD teams up with oncologic breast surgeon, Jay Harness, MD to demonstrate a nipple-sparing mastectomy (NSM) performed through an inframammary approach. Initially the oncoplastic team operates simultaneously through an inframammary incision and an axillary incision to free up the breast from the pectoralis fascia and dissect out the tail of the breast. The dissection through the inframammary incision is then carried out superficial to the anterior mammary fascia, dividing the individual Cooper's ligament close to the dermis. This important step in the mastectomy preserves the full thickness subcutaneous fat for improved blood supply to the skin and avoids leaving breast tissue behind. The subcutaneous fat is thinned out in a limited area overlying the cancer. The areola dissection is kept in the sub-dermal plane to remove all the adherent breast tissue. The thick breast skin flap allows fixing the temporary tissue expander in the pre-pectoral plane for future exchange with a permanent silicone gel implant using the pre-pectoral pocket. Of the different approaches that have been used for nipple-sparing mastectomy, the inframammary approach leaves the least visible scar and achieves the best overall aesthetic result. reconstruction.

Learning Objectives

After viewing this course, the participant should be able to:

• Outline the benefits of the oncologic breast surgeon working in concert with the plastic surgeon as a team in performing nipple-sparing mastectomy through an inframammary approach.
• Assess and plan the surgical approach preoperatively with the breast surgeon.
• Assess the psychological benefits for the cancer patient in an inframammary Nipple-Sparing Mastectomy.
• Implement postoperative management strategies after the first stage tissue expansion and after the insertion of the permanent silicone gel implant.
  
  

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

Disclosures
Drs. Salibian and Harness have nothing to disclose. All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.