1. Oncoplastic Procedures in Preparation for Nipple-Sparing Mastectomy and Autologous Breast Reconstruction
- Author
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Hani Sbitany, Suhail K. Kanchwala, and Arash Momeni
- Subjects
Adult ,Nipple-Sparing Mastectomy ,medicine.medical_specialty ,Mammaplasty ,Ubiquitin-Protein Ligases ,medicine.medical_treatment ,Breast surgery ,Breast Neoplasms ,030230 surgery ,Free Tissue Flaps ,Transplantation, Autologous ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ptosis ,Humans ,Medicine ,Breast ,Mastectomy ,Retrospective Studies ,BRCA2 Protein ,business.industry ,Retrospective cohort study ,Hypertrophy ,Middle Aged ,Surgery ,Transplantation ,Nipples ,030220 oncology & carcinogenesis ,Mutation ,Female ,medicine.symptom ,business ,Breast reconstruction ,Organ Sparing Treatments ,Envelope (motion) - Abstract
Nipple-sparing mastectomy has been associated with superior aesthetic outcomes and oncologic safety. However, traditional contraindications, such as breast ptosis/macromastia, have excluded a large number of patients. The purpose of this study was to determine whether a staged approach would expand the indications for nipple-areolar complex preservation and permit greater control over nipple-areolar complex position and skin envelope following autologous reconstruction.A retrospective analysis was conducted of female patients with a diagnosis of breast cancer or BRCA mutation with grade 2 or 3 ptosis and/or macromastia who underwent bilateral (oncoplastic) reduction/mastopexy (stage 1) followed by bilateral nipple-sparing mastectomy with immediate reconstruction with free abdominal flaps (stage 2). The authors were specifically interested in the incidence of mastectomy skin necrosis and nipple-areolar complex necrosis and malposition following stage 2.Sixty-one patients with a mean age of 45.1 years (range, 28 to 62 years) and mean body mass index of 32.6 kg/m (range, 23.4 to 49.0 kg/m) underwent reconstruction with 122 flaps. The mean interval between stage 1 and 2 was 16.9 weeks (range, 3 to 31 weeks). Clear margins were obtained in all cases of invasive cancer and in situ disease following stage 1. Complications following stage 2 included partial nipple-areolar complex necrosis (n = 5, 8.2 percent), complete nipple-areolar complex necrosis (n = 4, 6.6 percent), nipple-areolar complex malposition (n = 1, 1.6 percent), and mastectomy skin necrosis (n = 4, 6.6 percent). No flap loss was noted in this series.Patients with moderate to severe breast ptosis and/or macromastia who wish to undergo mastectomy with reconstruction can be offered nipple-sparing approaches safely if a staged algorithm is implemented.Therapeutic, IV.
- Published
- 2020