Abstract: Nipple-Sparing Mastectomy In Patients With A History Of Reduction Mammaplasty Or Mastopexy: An Updated Experience Demonstrating Its Safety (Plastic Surgery 2013)

Monday, October 14, 2013: 10:35 AM

Michael Alperovich, MD , Plastic Surgery, New York University Langone Medical Center, New York, NY

Neil Tanna, MD , Plastic Surgery, North Shore Long Island Jewish Medical Center, Manhasset, NY

Fares Samra, MD , Plastic Surgery, University of Pennsylvania, Philadelphia, PA

Keith M Blechman, MD , Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX

Richard L Shapiro, MD , Surgery, New York University, New York, NY

Amber A Guth, MD , Surgery, New York University, New York, NY

Deborah M Axelrod, MD , Surg, New York University, New York, NY

Mihye Choi, MD , Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY

Nolan S. Karp, MD , Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY

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PURPOSE: Nipple-sparing mastectomy has gained popularity, but the question remains whether it can be offered safely to women with prior history of reduction mammaplasty or mastopexy. Significant breast surgery in the past may have an increased theoretical risk to nipple-areolar complex and mastectomy flap viability. Presented is our updated experience with offering nipple-sparing mastectomy to this patient population.

METHODS AND MATERIALS: Patients at our institution who had reduction mammaplasty or mastopexy prior to nipple-sparing mastectomy were identified and their records reviewed. Outcomes measured include nipple-areolar complex viability, mastectomy flap necrosis, infection, cancer in the nipple-areolar complex and breast cancer recurrence.

RESULTS: The records of our nipple-sparing mastectomy patients from 2006 through 2012 were reviewed. We present eleven patients (n=19 breasts) who underwent nipple-sparing mastectomy following reduction mammaplasty or mastopexy. Seventeen breasts had reduction mammaplasties while the remaining two had mastopexies. In all cases, reduction mammaplasty or mastopexy were in the patient’s surgical history and not performed as part of a planned two stage nipple-sparing mastectomy procedure.

The mean age of the patients was 47.5 and the mean BMI was 27.6. None of the patients in this subset were diabetic, and one patient was a smoker. Twelve breasts had therapeutic resections, and seven were for prophylactic indications. Average time elapsed between reduction mammaplasty or mastopexy and nipple-sparing mastectomy was 104.3 months (range, 33 days to 40 years).

Fourteen patients were reconstructed immediately with tissue expanders, one with a latissimus dorsi flap with immediate implant and four with immediate transverse rectus abdominis myocutaneous free flaps. Prior reduction mammaplasty or mastopexy incisions were used in all cases.

Complications included one hematoma requiring evacuation, one breast with mastectomy flap necrosis, and one displaced implant requiring revision. There were no positive subareolar biopsies. Nipple viability complications included a partial necrosis rate of 15.8% with no cases of complete necrosis. Mean follow-up time was 14.5 months.

CONCLUSIONS: Our updated experience demonstrates that the outcomes of nipple-sparing mastectomy in patients with a history of reduction mammaplasty or mastopexy are comparable to the standards for patients who undergo nipple-sparing mastectomy alone. Patients presenting for mastectomy and reconstruction can be offered nipple-sparing mastectomy despite significant breast surgery in the past.

23099 Nipple-Sparing Mastectomy In Patients With A History Of Reduction Mammaplasty Or Mastopexy: An Updated Experience Demonstrating Its Safety