Nipple-Sparing Mastectomy and Breast Reconstruction with a Deep Inferior Epigastric Perforator Flap Using Thoracodorsal Recipient Vessels and a Low Lateral Incision

BACKGROUND:  Increased incidence of nipple-sparing mastectomies poses challenges in providing aesthetically-pleasing and inconspicuous scars especially in the setting of autologous breast reconstruction. A unique technique of nipple-sparing mastectomy breast reconstruction using free flaps and the thoracodorsal (TD) system is described.

METHODS: Between December 2010 and 2016 December, patients who underwent autologous reconstruction using TD recipient vessels were investigated. Complication and revision rates were compared to using the internal mammary (IM) vessels. Patient reported outcomes were determined.

RESULTS: 79 nipple-sparing mastectomy reconstructions, 30 used TD and 49 used IM recipient vessels. There was not a significant difference in age, BMI, ischemia time, and specimen/ flap- harvested /flap-used weights between two groups. There was a statistically significant difference in artery size (p =0.01), the IM artery 2.7±0.43 large than the TD artery 1.8±0.4. There was not a statistical difference with breast hematoma, infection, partial flap loss, re-open rate, flap failure, fat necrosis, abdominal site hematoma, hernia/bulge, umbilical wound dehiscence, or total complications between two groups. Breast-Q “psychosocial well-being” had a statistically significantly higher score in the TD group (p = 0.04), the mean score was 83.9±14.6 in the TD group and 72.8±17.6 in IM group.

CONCLUSION: This technique provides a low lateral, and inconspicuous incision in nipple-sparing mastectomy with autologous breast reconstruction with a low complication and revision rate and higher psychosocial well-being scores than IM vessels.