Abstract: Breast Reconstruction Following Nipple-Sparing Mastectomy: Predictors of Complications (Plastic Surgery 2013)

Saturday, October 12, 2013: 2:15 PM

Amy S. Colwell, MD , Plastic Surgery, Massachusetts General Hospital, Boston, MA

Oren Tessler, MD, MA , Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA

Alex M Lin, BS , Plastic Surgery, Massachusetts General Hospital, Boston, MA

Eric Liao, MD, PhD , Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Jonathan M. Winograd, MD , Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA

Curtis Cetrulo, Jr, MD , Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, New York, NY

Rong Tang, MD , Plastic Surgery, Massachusetts General Hospital, Boston, MA

Barbara Smith, MD , Surgical Oncology, Massachusetts General Hospital, Boston, MA

William G Austen, MD , Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA

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Purpose:

Nipple-sparing mastectomy (NSM) is increasingly used for treatment and prevention of breast cancer. Little data exists to categorize risk factors for complications in NSM reconstruction and their influence on reconstruction type.

METHODS:

Single institution retrospective review was performed between 2007-2012 for NSM procedures and reconstruction.

RESULTS:

Two hundred eighty-five patients, median age 46 years (range 25-78), underwent 500 nipple-sparing mastectomy procedures for breast cancer (46%) or risk reduction (54%) (Figure1 preoperative and postoperative photos). The average BMI was 24, and 6% were smokers. Procedures were performed utilizing inferolateral inframammary fold (IMF) (51%), periareolar (24%), lateral radial (10%), inferior radial (4%), or pre-existing scar (11%) incisions (Ref.1). Immediate breast reconstruction (n= 494, reconstruction rate 98.8%) was performed with direct-to-implant (DTI) (59%), tissue expander-implant (38%), or autologous (3%) reconstruction. Seventy-one percent had ADM-assisted reconstruction and 11% had mesh. Forty-two reconstructions had prior radiation and 30 received postoperative radiation to the tissue expander (n=11) or implant (n=19). The nipple areolar complex was partially or totally removed in 45 (9%) reconstructions due to ischemia (n=21), a positive cancer margin (n=18) or for symmetry (n=6).

Complications included infection (3.3%), skin necrosis (5.2%), partial or total nipple necrosis (4.4%), seroma (1.7%), and hematoma (1.7%) leading to implant loss in 1.9%. The number of breasts having one or more complications was 60 (12.4%) compared to 422 breasts (87.6%) with no complication. The complication rate was influenced by incision type with the inferolateral inframammary fold incision having the lowest complication rate (8.5%) and the periareolar incision having the highest complication rate (21.1%) (p<0.01 respectively). Smoking and BMI were risk factors for skin necrosis, and preoperative radiation predicted nipple necrosis (p<0.05 for each). The average implant volume in DTI reconstructions was higher in patients with a complication compared to without a complication (p<0.02). The inferolateral inframammary fold incision had more direct-to-implant reconstructions (67.5%, p<0.03), while the inferior radial incision and smoking decreased DTI reconstructions (p<0.008). A patient survey showed preference for the inferolateral IMF incision (75.4%).

CONCLUSIONS:

Nipple-sparing mastectomy procedures have a high reconstructive rate and a low number of complications. Smoking, BMI, implant volume, preoperative radiation, and incision type were predictors of complications.

22678 Breast Reconstruction Following Nipple-Sparing Mastectomy: Predictors of Complications