Omega and Reverse Omega Incisions: Techniques for Immediate or Delayed Reconstruction of Mildly Ptotic and Larger Breasts Following Nipple-Sparing Mastectomy

Abstract Background Breast-Conserving Therapy (BCT) has become a widely accepted treatment option for selected breast cancer cases. Nipple-Sparing Mastectomy (NSM) is considered an effective and oncologically safe approach for certain patients, as it preserves the native skin and nipple, allowing for one- or two-stage reconstruction with optimal cosmetic outcomes. This study aimed to provide our department’s experience utilising the Omega and Reverse Omega incision techniques for immediate or delayed breast reconstruction for patients who had undergone NSM. Method Our study included sixteen cancer patients with mildly ptotic and large breasts who underwent immediate or delayed breast reconstruction using prosthetic implants following NSM, where the Omega incision was utilised, either bilaterally or unilaterally, from January 2022 to December 2024, at the Plastic and Reconstructive Surgery Department of Nicosia General Hospital. Patient demographics, co-morbidities, pre- and postoperative breast anthropometric measurements, and surgical complications were recorded and analysed. Results Sixteen patients underwent a total of twenty-one nipple-sparing mastectomy procedures for either breast cancer (90.47%) or risk reduction (9.52%), followed by breast reconstruction. The average age at the time of reconstruction was 64.4 years. The mean preoperative body mass index was 26.73 kg/m 2 , and 25% were smokers. The mean follow-up was 11.62 months. From the patients who had undergone NSM, 12 (75%) were in the immediate reconstruction group, while the other 4 (25%) belonged to the delayed reconstruction group. Unilateral breast reconstruction was performed in 11 (52.38%) breasts. Bilateral NSM and immediate reconstruction with pre-pectoral implants was performed in 10 (47.61%) breasts. The Reverse Omega technique was performed in seven breasts. Single-stage breast reconstruction was performed for 17 (80.95%) breasts, while two-stage reconstruction for 4 (19.05%). Complications were reported, including a case of haematoma 1 (4.76%) and three cases of implant loss (14.28%). Conclusion The Omega incision appears to be a safe and effective technique for immediate or delayed reconstruction for selected cases of NSM eligible cancer patients with slightly ptotic and/or larger breasts. Level of Evidence IV Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.