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Oncoplastic Procedures in Preparation for Nipple-Sparing Mastectomy and Autologous Breast Reconstruction
- Source :
- Plastic and Reconstructive Surgery. 145:914-920
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
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.
- 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)
Subjects
Details
- ISSN :
- 00321052
- Volume :
- 145
- Database :
- OpenAIRE
- Journal :
- Plastic and Reconstructive Surgery
- Accession number :
- edsair.doi.dedup.....cc5b496f4131a4b226e100649622bc32