Safety and optimal timing of staged nipple-sparing mastectomy following nipple repositioning in ptotic breasts: a systematic review protocol

Yousef Tanas; Grace Gasper; Sarya Swed; Aldona J. Spiegel

doi:10.1186/s13643-026-03129-6

Safety and optimal timing of staged nipple-sparing mastectomy following nipple repositioning in ptotic breasts: a systematic review protocol

Yousef Tanas, Grace Gasper, Sarya Swed, Aldona J. Spiegel

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.

METHODS: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I 2 statistics, and p-value for overall effect.

DISCUSSION: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.

SYSTEMATIC REVIEW REGISTRATION: ROSPERO CRD42024513738.

Original language	English (US)
Article number	137
Journal	Systematic Reviews
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s13643-026-03129-6
State	Published - Mar 3 2026

Keywords

Breast reduction
Complications
Mastopexy
Nipple-sparing mastectomy
Oncologic safety
Humans
Mastectomy/methods
Nipples/surgery
Time Factors
Breast/surgery
Breast Neoplasms/surgery
Systematic Reviews as Topic
Female
Mammaplasty/methods
Hypertrophy

ASJC Scopus subject areas

Medicine (miscellaneous)

Divisions

Surgical Innovation
Plastic and Reconstructive Surgery

Access to Document

10.1186/s13643-026-03129-6

Cite this

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title = "Safety and optimal timing of staged nipple-sparing mastectomy following nipple repositioning in ptotic breasts: a systematic review protocol",

abstract = "BACKGROUND: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.METHODS: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I 2 statistics, and p-value for overall effect. DISCUSSION: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.SYSTEMATIC REVIEW REGISTRATION: ROSPERO CRD42024513738.",

keywords = "Breast reduction, Complications, Mastopexy, Nipple-sparing mastectomy, Oncologic safety, Humans, Mastectomy/methods, Nipples/surgery, Time Factors, Breast/surgery, Breast Neoplasms/surgery, Systematic Reviews as Topic, Female, Mammaplasty/methods, Hypertrophy",

author = "Yousef Tanas and Grace Gasper and Sarya Swed and Spiegel, \{Aldona J.\}",

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doi = "10.1186/s13643-026-03129-6",

language = "English (US)",

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AU - Tanas, Yousef

AU - Gasper, Grace

AU - Swed, Sarya

AU - Spiegel, Aldona J.

PY - 2026/3/3

Y1 - 2026/3/3

N2 - BACKGROUND: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.METHODS: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I 2 statistics, and p-value for overall effect. DISCUSSION: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.SYSTEMATIC REVIEW REGISTRATION: ROSPERO CRD42024513738.

AB - BACKGROUND: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.METHODS: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I 2 statistics, and p-value for overall effect. DISCUSSION: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.SYSTEMATIC REVIEW REGISTRATION: ROSPERO CRD42024513738.

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KW - Time Factors

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KW - Breast Neoplasms/surgery

KW - Systematic Reviews as Topic

KW - Female

KW - Mammaplasty/methods

KW - Hypertrophy

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Safety and optimal timing of staged nipple-sparing mastectomy following nipple repositioning in ptotic breasts: a systematic review protocol

Abstract

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