scholarly journals Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

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.

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

Mastology ◽  
2021 ◽  
Author(s):  
Marina Sonagli ◽  
Eduardo Bertolli ◽  
Alexandre Katalinic Dutra ◽  
Hirofumi Iyeyasu ◽  
Fabiana Baroni Alves Makdissi
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Skin Flap ◽  
Cancer Center ◽  
Flap Necrosis ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Skin Flap Necrosis

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.

Outcomes of Nipple-Sparing Mastectomy: Role of Anatomic Measurements

2016 ◽  
Vol 82 (10) ◽  
pp. 944-948
Author(s):  
Seyed S. Pairawan ◽  
Derek Cody ◽  
Hahns Kim ◽  
M. Katherine Hughes ◽  
Naveenraj Solomon ◽  
...  
Keyword(s):  
Wound Care ◽  
Skin Flap ◽  
Inframammary Fold ◽  
Sternal Notch ◽  
Increased Risk ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Care Requirements ◽  
Base Width

Nipple-sparing mastectomy (NSM) offers improved cosmesis for women undergoing mastectomy; however, there is increased risk for complications with this technique. We sought to determine if standard anatomic measurements could be used to predict complications of NSM. We performed a retrospective review of NSM for which anthropometric measurements of sternal notch to nipple distance, base width, and inframammary fold to nipple distance were available, and compared outcomes by anatomic measurements. We identified 102 cases of NSM with measurements available for study performed in 55 patients. Areola necrosis was associated with base width of greater than 15 cm (42.9% vs 10.9%, P = 0.02), infections were more likely with inframammary fold to nipple distance of more than 10 cm (29.2% vs 10.3%, P = 0.02), hematomas were more likely with sternal notch to nipple distance more than 30 cm (22.2% vs 4.3%, P = 0.03), and delayed wound healing was more likely with sternal notch to nipple distance of more than 25 cm (10.3% vs 1.6%, P = 0.03). There were no significant differences in nipple necrosis, skin flap necrosis, wound care requirements, or operative intervention based on anatomic measurement. Standard anatomic measurements are inconsistent predictors of outcome from NSM and should not be used alone to exclude attempts at NSM.

scholarly journals Immediate breast reconstruction with definitive pre-pectoral prosthesis after nipple sparing mastectomy through inframammary fold without using an acellular matrix: result of 13o cases

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Alessandra Amatuzi Cordeiro Fornazari ◽  
Leonardo Paese Nissen ◽  
Flavia Kuroda ◽  
Maíra Teixeira Dória ◽  
Cícero de Andrade Urban
Keyword(s):  
Breast Reconstruction ◽  
Statistical Significance ◽  
Inframammary Fold ◽  
Reconstruction Technique ◽  
Surgical Morbidity ◽  
Acellular Matrix ◽  
Aesthetic Result ◽  
Surgical Data ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Introduction: Breast reconstruction with prosthesis after mastectomy is currently the main reconstruction technique used in the world. The pre-pectoral prosthesis is progressively being more used, and has advantages in relation to the submuscular prosthesis, such as less pain in the postoperative period, decreased muscular deficit, breast animation, better aesthetic result, besides reducing the time of surgical morbidity, for being easier to execute. Objectives: To review the results and complications of patients submitted to breast reconstruction with definitive prosthesis without using an acellular matrix (ADM). Methods: Retrospective study including patients who underwent immediate reconstruction with pre-pectoral definitive prosthesis after nipple sparing mastectomy (NSM), with incision through the inframammary fold (IMD), without using ADM, between January, 2018, and July, 2019. We collected demographic data, types of therapy and surgical data. The complications and secondary surgical interventions were also assessed. The Fisher’s Exact Test was used for statistical analysis (p lower than 0.05). Results: During the study period, 130 reconstructions were performed in 87 patients. Mean age was 43 years. Thirty two mastectomy procedures (24.6%) presented at least one complication, and the most common ones were: flap necrosis (N=13), persistent seroma (N=10), and prosthesis exposure (N=9). Of this total, 21 were submitted to a new surgical procedure, and 12 (9.2%) evolved with loss of prosthesis in an average of 64 days (12 to 180 days) after the first surgery. The main risk factors associated with loss of prosthesis were smoking (OR 4; 1.48‒10.8) and BMI higher than 25 (OR 4.4; 1.24‒15.6), both with statistical significance (p<0.05). The presence of previous radiotherapy (42.8% x 21.5%) or adjuvant therapy (37.5% x 21.5%) and diabetes mellitus (42.9% x 23.6%) show a tendency to higher chances of complications, however, these were not statistically significant. The other assessed factors did not present correlation with the complications. Regarding the late aesthetic result, we only assessed the patients who were followed up for more than 6 months. Of the 52 breasts, 69.3% did not present capsular contracture, and 28.8% presented contracture in Grades I or II of the Baker scale. Rippling was identified in only 13 breasts (25%). There was no prosthesis dislocation or breast animation. Conclusion: Breast reconstruction with definitive pre-pectoral prosthesis after NSM using IMD is a promising, safe and economically advantageous technique, presenting results and complications similar to the cases that use ADM or place the retromuscular prosthesis.

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

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.

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

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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