“Breast in a Day”: Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy

Introduction:

Nipple-sparing mastectomy (NSM) with immediate, permanent implant reconstruction offers patients a prosthetic “breast in a day” compared to tissue expander techniques requiring multiple procedures.

Methods:

            Patients undergoing NSM with immediate, permanent implant reconstruction were reviewed with patient demographics and outcomes analyzed.

Results:

            Of 842 NSMs from 2006 to June 2015, 160 (19.0%) underwent immediate, permanent implant reconstruction. In 2012, 7.2% of patients undergoing NSM with prosthetic reconstruction had immediate, permanent implant reconstruction whereas this proportion was 37.6% in 2014. The average age and body mass index (BMI) of patients undergoing single-stage implant reconstruction after NSM were 46.5 years and 23.3, respectively. The majority of mastectomies (63.7%) were for prophylactic indications and were bilateral (86.3%). Six reconstructions (3.8%) had undergone previous radiation therapy while 5 (3.1%) underwent post-operative radiation therapy.

          The most common mastectomy incisions utilized were an inframammary fold incision (44.4%) followed by lateral inframammary fold incisions (25.0%). The majority of implants utilized were either Allergan Style 20 (48.1%) or Style 15 (22.5%). Shaped Allergan Style 410 implants were used in 11.3% of reconstructions. The average implant size was 376.2 milliliters (mL) and 91.3% of reconstructions utilized acellular dermal matrices (ADM) with AlloDerm (86.9%) being the most common. The average number of reconstructive operations was 1.3 as 21.9% of reconstructions underwent a secondary procedure. Follow-up was 21.9 months.

            The most common major complication was major mastectomy flap necrosis (8.1%). The rate of reconstructive failure was 5.6% while that for implant loss was 4.4%. The most common minor complication was minor mastectomy flap necrosis (14.4%). The rates of full thickness and partial thickness nipple necrosis were 4.4% and 7.5%, respectively. Rates of infection requiring intravenous and oral antibiotics were 2.5% and 1.9%, respectively.

            Independent risk factors for the occurrence of any complication were analyzed. Age greater than 50 (p=0.0276) and implant size greater than 400 mL (p=0.0467) emerged as independent predictors of overall complications. Obesity (p=0.4073), tobacco use (p=0.2749), prior radiation therapy (p=0.4613), and ADM (p=0.5305), along with other factors examined, were not associated with greater complication rates.

Conclusions:

            Immediate, permanent implant reconstruction in NSM provides patients with a “breast in a day” in less than two procedures with a low complication rate.