Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients

Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025).Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.

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Patient satisfaction after nipple-sparing mastectomy with intraoperative radiotherapy and breast reconstruction for breast cancer

Acta Chirurgica Belgica ◽

10.1080/00015458.2021.1952054 ◽

2021 ◽

pp. 1-8

Author(s):

Xiaoshen Zhang ◽

Jinhui Liu ◽

Lingxiao Pan ◽

Wenbo Zheng ◽

Lun Chen ◽

...

Keyword(s):

Breast Cancer ◽

Patient Satisfaction ◽

Breast Reconstruction ◽

Intraoperative Radiotherapy ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: Aesthetic outcomes and mitigating nipple-areolar complex necrosis

Archives of Plastic Surgery ◽

10.5999/aps.2017.01067 ◽

2018 ◽

Vol 45 (3) ◽

pp. 229-238 ◽

Cited By ~ 2

Author(s):

Wan-Sze Pek ◽

Bien-Keem Tan ◽

Yvonne Ying Ru Ng ◽

Veronique Kiak Mien Tan ◽

Mohamed Zulfikar Rasheed ◽

...

Keyword(s):

Breast Reconstruction ◽

Asian Population ◽

Immediate Breast Reconstruction ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience

Scientific Reports ◽

10.1038/s41598-019-51744-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Hyung Seok Park ◽

Jeea Lee ◽

Dong Won Lee ◽

Seung Yong Song ◽

Dae Hyun Lew ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Learning Curve ◽

Operation Time ◽

Immediate Breast Reconstruction ◽

Robot Assisted ◽

Open Conversion ◽

Areolar Complex ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

Abstract Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.

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Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique

Surgery Today ◽

10.1007/s00595-020-02175-4 ◽

2020 ◽

Author(s):

Uhi Toh ◽

Miki Takenaka ◽

Nobutaka Iwakuma ◽

Yoshito Akagi

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Gene Mutations ◽

Cost Effective ◽

Standard Of Care ◽

Areolar Complex ◽

Cost Effective Method ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Breast Reconstructive Surgery

AbstractAdvances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple–areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients’ cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR.

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Nipple-sparing mastectomy: Evaluation of oncologic safety and aesthetic outcomes in 94 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.97 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 97-97

Author(s):

E. C. Millen ◽

R. R. Pinto ◽

L. Menezes ◽

F. C. O. Almeida ◽

G. Novita ◽

...

Keyword(s):

Breast Conservation ◽

Tissue Expander ◽

Radical Mastectomy ◽

Breast Conservation Therapy ◽

Axillary Node ◽

Tertiary Referral Hospital ◽

Immediate Reconstruction ◽

Areolar Complex ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

97 Background: The surgical treatment of breast cancer has evolved from radical mastectomy to breast conservation therapy. Today we have another therapeutic dilemma: how to manage the nipple-areolar complex (NAC) in mastectomy offering patients better aesthetic results with oncologic safety. Methods: We analyzed data on 125 consecutive nipple- or skin-sparing mastectomies (SSM) with immediate reconstruction with tissue expander, prosthesis or autologous tissue performed in 94 patients from 2003 to 2010 in a tertiary referral hospital. Nipple-sparing mastectomy (NSM) was performed for treatment disease (n= 94) and prophylaxis of contralateral breast or symmetrization in selected cases (n= 31). Results: Mean patients age was 46.8 years (range 27 to 69 years) and mean follow-up time was 27.2 months (range 2 weeks to 81 months). Twelve patients were stage 0, 41 stage I, 35 stage II A and B and 7 stage III. There were 125 nipple- or areola-sparing mastectomies (31 bilateral and 94 unilateral), including 112 NSM and 13 SSM. On pathologic review, 12 breasts had carcinoma in situ, 83 invasive carcinoma, and 31 breasts were cancer free. Thirteen nipples (13.8%) were compromised by tumor on subareolar biopsy and were removed. The location and type of incision was variable according to the tumor site and previous patient scar. Periareolar incision with prolongation along the inferior pole of breast was the preferred method. Patients with positive axillary node (27.5%) received adjuvant radiotherapy. There was no nipple necrosis. One patient presented local relapse in the skin-sparing group within 24 months. Conclusions: These data demonstrate that NSM is oncologically safe and can be performed with all types of breast reconstruction.

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