Postoperative complications following simultaneous therapeutic and contralateral prophylactic nipple-sparing mastectomy: a retrospective study

Introduction: Nipple-Sparing Mastectomy (NSM) is increasingly indicated for therapeutic and prophylactic purposes due to better cosmetic results with nipple maintenance. Postoperative complications have not been compared among patients who have undergone simultaneous therapeutic and contralateral prophylactic NSM. The aim of the present study was to evaluate the incidence and risk factors for postoperative complications in bilateral/unilateral NSMs, and therapeutic and/or prophylactic NSMs. Methods: Retrospective study of patients who underwent NSM between 2007 and 2017 at A.C. Camargo Cancer Center. Results: Among 290 patients, 367 NSMs were performed, 64 simultaneous therapeutic and contralateral prophylactic NSM. The latter were associated with more postoperative complications (OR=3.42; p=0.002), mainly skin flap necrosis (OR=3.79; p=0.004), hematoma (OR=7.1; p=0.002), wound infection (OR=3.45; p=0.012), and nipple-areola complex (NAC) loss (OR=9.63; p=0.003). Of the 367 NSMs, 213 were unilateral NSMs, which were associated with lower rates of postoperative complications (OR=0.44; p=0.003), especially skin flap necrosis (OR=0.32; p=0.001), hematoma (OR=0.29; p=0.008), wound infection (OR=0.22; p=0.0001), and reoperation (OR=0.38; p=0.008). Obesity was related to more postoperative complications (OR=2.55; p=0.01), mainly hematoma (OR=3.54; p=0.016), reoperation (OR=2.68; p=0.023), and NAC loss (OR=3.54; p=0.016). Patients’ age (p=0.169), their smoking status (p=0.138), breast ptosis (0.189), previous chest radiotherapy (p 1), or previous breast surgery (p=0.338) were not related to higher chances of postoperative complications. Conclusions: Results suggest that performing therapeutic and contralateral prophylactic NSM as separated procedures may represent a good strategy for minimizing postoperative complications.

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Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

Cancer and Clinical Oncology ◽

10.5539/cco.v5n1p102 ◽

2016 ◽

Vol 5 (1) ◽

pp. 102

Author(s):

Umbareen Mahmood ◽

Jessica Suber ◽

Ronit Zadikany ◽

Brian Kellogg ◽

William Fulp ◽

...

Keyword(s):

Skin Flap ◽

Smoking History ◽

Inframammary Fold ◽

Flap Necrosis ◽

Eligibility Criteria ◽

Immediate Reconstruction ◽

Aesthetic Result ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Skin Flap Necrosis

Background: Nipple-sparing mastectomy (NSM) is a technically feasible and oncologically sound option for patients who meet eligibility criteria. Inframammary fold (IMF) incision results in a well-hidden scar and enhanced final aesthetic result. While oncologic eligibility criteria have been well established, reconstructive criteria are less defined. We report Moffitt Cancer Center's (MCC) outcomes with IMF incision for NSM and immediate reconstruction, and factors associated with increased complication rate.Methods: IRB approved retrospective cohort study of patients who underwent NSM through an IMF approach with immediate reconstruction at MCC from 2006-2013 was conducted. Analysis included patient demographics, tumor characteristics, ancillary treatment, reconstructive method, and nipple and skin flap necrosis. A literature review was performed to compare outcomes with other types of incisions.Results: 115 patients met inclusion criteria, representing 199 breasts. The average age was 48.1 (range 18-74). The two main complication categories evaluated were nipple necrosis (8%) and skin flap necrosis (10.6%). Older age demonstrated a significant relationship with skin flap necrosis (p=0.0155) and overall complications (p=0.0492). Complication rate was significantly higher in the cancer side vs. prophylactic side in patients who underwent bilateral mastectomies (p=0.0088). Factors with trends related to increased skin flap necrosis included increased mastectomy specimen weight (p=0.0704), smoking (p=0.0726), and significant comorbidities (p=0.0665).Conclusion: Our institution's results substantiate that NSM through an IMF approach with immediate reconstruction is a viable option. Recognized risk factors such as age, laterality, breast weight, smoking history, and comorbidities associated with increased complications should be considered when determining patient selection for reconstruction.

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The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy

Archives of Plastic Surgery ◽

10.5999/aps.2017.00934 ◽

2017 ◽

Vol 44 (6) ◽

pp. 509-515 ◽

Cited By ~ 10

Author(s):

Min Ho Yun ◽

Eul Sik Yoon ◽

Byung-Il Lee ◽

Seung-Ha Park

Keyword(s):

Breast Reconstruction ◽

Low Dose ◽

Skin Flap ◽

Flap Necrosis ◽

Nitroglycerin Ointment ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Skin Flap Necrosis

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Systematic Review and Meta-analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab028 ◽

2021 ◽

Author(s):

Maria Chicco ◽

Ali R Ahmadi ◽

Hsu-Tang Cheng

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Meta Analysis ◽

Skin Flap ◽

Prosthetic Reconstruction ◽

Hematoma Formation ◽

Significant Difference ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Early Late

Abstract Background There is limited evidence available in literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. Objectives The purpose of this systematic review and meta-analysis is to compare postoperative complications between women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. Methods A systematic search was conducted in February 2020 for studies comparing women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late and overall complications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through meta-analysis. Results Our meta-analysis, which included six studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the two groups in rates of early (36.7% vs. 24.8%; OR=1.57, 95% CI 0.94 to 2.64; P=0.09), late (10.1% vs. 19.9%; OR=0.53, 95% CI 0.06 to 4.89; P=0.57) and overall complications (36.5% vs. 31.2%; OR=1.23, 95% CI 0.76 to 2.00; P=0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% versus 2.15%; OR=2.68, 95% CI 1.00 to 7.16; P=0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis and prosthesis loss. Conclusions Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

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

Breast Cancer Research and Treatment ◽

10.1007/s10549-012-1983-y ◽

2012 ◽

Vol 132 (3) ◽

pp. 1177-1184 ◽

Cited By ~ 22

Author(s):

F. Didier ◽

P. Arnaboldi ◽

S. Gandini ◽

A. Maldifassi ◽

A. Goldhirsch ◽

...

Keyword(s):

Nipple Areola Complex ◽

Areola Complex ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

Journal of Robotic Surgery ◽

10.1007/s11701-021-01265-w ◽

2021 ◽

Author(s):

M. D. Filipe ◽

E. de Bock ◽

E. L. Postma ◽

O. W. Bastian ◽

P. P. A. Schellekens ◽

...

Keyword(s):

Postoperative Complication ◽

Complication Rate ◽

Primary Outcome ◽

Meta Analysis ◽

Complication Rates ◽

Flap Necrosis ◽

Postoperative Complication Rate ◽

Common Cancer ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

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