scholarly journals Optimizing Aesthetic Outcomes in Breast Reconstruction After Nipple-Sparing Mastectomy

2020 ◽  
Vol 40 (Supplement_2) ◽  
pp. S13-S21
Author(s):  
Mihye Choi ◽  
Jordan D Frey
Keyword(s):  
Breast Reconstruction ◽  
Preoperative Evaluation ◽  
Management Strategies ◽  
Oncologic Outcomes ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
Skin Envelope ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Nipple-sparing mastectomy (NSM) has been associated with improved quality of life and patient satisfaction with similar oncologic outcomes compared with traditional mastectomy techniques. By conserving the nipple-areola complex and the majority of the breast skin envelope, NSM allows for improved aesthetic outcomes after breast reconstruction. However, the technique is also associated with a steep learning curve that must be considered to achieve optimal outcomes. It is important that the plastic surgeon functions in concert with the extirpative breast surgeon to optimize outcomes because the reconstruction is ultimately dependent on the quality of the overlying mastectomy flaps. Various other factors influence the complex interplay between aesthetic and reconstructive outcomes in NSM, including preoperative evaluation, specific implant- and autologous-based considerations, as well as techniques to optimize and correct nipple-areola complex position. Management strategies for complications necessary to salvage a successful reconstruction are also reviewed. Lastly, techniques to expand indications for NSM and maximize nipple viability as well as preshape the breast are discussed. Through thoughtful preoperative planning and intraoperative technique, ideal aesthetic results in NSM may be achieved.

scholarly journals Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

2015 ◽  
Vol 42 (5) ◽  
pp. 601 ◽  
Author(s):  
Jin-Woo Cho ◽  
Eul-Sik Yoon ◽  
Hi-Jin You ◽  
Hyon-Surk Kim ◽  
Byung-Il Lee ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Nipple Areola Complex ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Why do women accept to undergo a nipple sparing mastectomy or to reconstruct the nipple areola complex when nipple sparing mastectomy is not possible?

2012 ◽  
Vol 132 (3) ◽  
pp. 1177-1184 ◽  
Author(s):  
F. Didier ◽  
P. Arnaboldi ◽  
S. Gandini ◽  
A. Maldifassi ◽  
A. Goldhirsch ◽  
...  
Keyword(s):  
Nipple Areola Complex ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

scholarly journals Nipple-Areola Complex Sensation after Nipple-sparing Mastectomy

2018 ◽  
Vol 6 (4) ◽  
pp. e1716 ◽  
Author(s):  
Prakasit Chirappapha ◽  
Pongsakorn Srichan ◽  
Panuwat Lertsithichai ◽  
Panya Thaweepworadej ◽  
Thongchai Sukarayothin ◽  
...  
Keyword(s):  
Nipple Areola Complex ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Nipple-sparing mastectomy and immediate breast reconstruction: Critical appraisal of five-year, single-center outcomes.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 99-99
Author(s):  
D. Westbroek ◽  
K. Mann ◽  
M. Ho ◽  
I. Gukas ◽  
I. Karat ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Patient Selection ◽  
Disease Free Survival ◽  
Immediate Breast Reconstruction ◽  
Tissue Loss ◽  
Free Survival ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Disease Free

99 Background: Approximately 5,000 patients undergo breast reconstruction annually in the United Kingdom (2:1 ratio of immediate versus delayed respectively). Preservation of the breast envelope, i.e., skin and nipple areola complex (NAC) improves cosmesis. While skin-sparing mastectomy is an accepted modality for local control in appropriately selected patients, nipple-sparing mastectomy (NSM) remains controversial. In over 1,800 published NSM cases, the local event rate attributable to NAC preservation following NSM (therapeutic and prophylactic) is 0.16% with no evidence of deleterious impact on disease-free survival. In our cohort, patient selection criteria included: preoperative lesion characterisation; 5-mm margin acceptance; submission of separate nipple core specimens for paraffin block histological assessment and re-excision of all involved margins. This study is intended to evaluate the efficacy of loco-regional control in a consecutive cohort of patients, under uniform conditions undergoing nipple-sparing mastectomy and immediate breast reconstruction. We highlight the surgical technique used and propose in/exclusion criteria for appropriate patient selection. Methods: 84 consecutive patients underwent NSM and IBR at Frimley Park Hospital, Surrey, UK (IJL, RD) between January 2004 and December 2008. Data was accrued retrospectively from the institution’s clinical coding, electronic records, and WinPath database. Endpoints recorded include: the incidence of (occult) malignancy at the nipple margins; NAC subcutaneous tissue loss; local (NAC) recurrence rates and disease free survival. Results: The mean age was 51.1 years and follow-up 4.9 years. There was one case of local recurrence in a patient who declined re-excision of close/involved margins. The immediate peri-operative complication rate was within the national mastectomy breast reconstruction audit outcome guidelines. Conclusions: In appropriately selected patients, our findings support nipple preservation at the time of mastectomy and immediate reconstruction as this enhances the cosmetic outcome without compromising oncologic safety.

scholarly journals The Changing Face of Mastectomy (from Mutilation to Aid to Breast Reconstruction)

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Stefano Zurrida ◽  
Fabio Bassi ◽  
Paolo Arnone ◽  
Stefano Martella ◽  
Andres Del Castillo ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Psychological Impact ◽  
Breast Conserving Surgery ◽  
Primary Treatment ◽  
Immediate Breast Reconstruction ◽  
The Past ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
New Skin

Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.

scholarly journals Prophylactic Bilateral Nipple-sparing Mastectomy and a Staged Breast Reconstruction Technique: Preliminary Results

2016 ◽  
Vol 10 ◽  
pp. BCBCR.S40033 ◽  
Author(s):  
Thierry Tondu ◽  
Filip Thiessen ◽  
Wiebren A.A. Tjalma
Keyword(s):  
High Risk ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Tissue Expander ◽  
Prophylactic Surgery ◽  
Reconstruction Technique ◽  
High Risk Women ◽  
Areola Complex ◽  
Skin Envelope ◽  
Nipple Sparing

More high-risk women with breast cancer are identified using genetic testing at a younger age. These young women often opt for prophylactic surgery. Most patients are reluctant for extra donor-site scars besides infections and necrosis. In order to reduce these risks, a two-stage breast reconstruction technique is used for high-risk women with large or ptotic breasts. We presume that this procedure will reduce the risk of skin envelope and nipple–areola complex (NAC) necrosis to less than 1%. In the first stage, an inferior pedicle reduction is performed to obtain large volume reduction with maximal safety for the NAC. The ptosis, skin excess, and malpositioning of the NAC are corrected safely at this stage. In the second stage, the skin-sparing mastectomy is performed with or without nipple sparing. During this procedure, the areola is never removed. A bilateral breast reconstruction is then performed with an immediate subpectoral prothesis or delayed with the use of a subpectoral tissue expander. In this way, we aim to meet the patient's wish to undergo bilateral risk reducing mastectomy in breasts that need ptosis correction without donor-site scarring. This article describes the procedure and reports the preliminary data.

Sign in / Sign up

Export Citation Format

Share Document