A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection Criteria

Woerdeman, Leonie A. E.; Hage, J. Joris; Hofland, Marjolein M. I.; Rutgers, Emiel J.

doi:10.1097/01.prs.0000246379.99318.74

Cited by 164 publications

(80 citation statements)

References 21 publications

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“…In addition, obese patients are likely to have additional complications due to associated vascular disease. Similarly as observed by Wooderman et al [79] , the authors observed that specimen weight more than the mean weight seems to be associated with statistically significant odds ratios to develop complications [33] . This aspect can be partially explained by a decreased perfusion of the relatively large skin flaps that result from SSM in much larger breasts.…”

Section: Skin Flap and Nac Complicationssupporting

confidence: 61%

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Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Munhoz

Montag

Filassi

et al. 2014

WJCO

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Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon' s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast reconstruction; Skin-sparing mastectomy; Nipple-sparing mastectomy; Outcome; Complications; Silicone breast implants; Tissue expanders; Oncoplastic surgery Core tip: In selected patients, nipple-sparing mastectomy (NSM) has allowed an adequate oncologic control with satisfactory aesthetic outcome. In addition, utilizing the native breast skin optimizes the aesthetic outcome of the reconstructed breast and minimizes postmastectomy deformity. The satisfactory results are due to a close collaboration with the oncological surgical ed the technique for benign diseases, however he did not report the procedure for oncological objectives or as a risk-reduction alternative [10,11] . Recently, there has been an increase in clinical experience studies of NSM for breast cancer prophylaxis or early cancer treatment, evidencing revived interest in this surgical procedure [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43...

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Section: Skin Flap and Nac Complicationssupporting

confidence: 61%

“…Some authors suggest that clinical co-morbidities are relevant risk factors for complications [5,6,28,33,[77][78][79][80][81][82] . Komorowski et al [28] analyzed such factors and concluded that age below 45 years is associated with a reduced risk of necrosis.…”

Section: Skin Flap and Nac Complicationsmentioning

confidence: 99%

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Munhoz

Montag

Filassi

et al. 2014

WJCO

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“…It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62). The same seems to be true for implant-based reconstructions (16,35,44,(63)(64)(65), but not all studies can confirm these findings (52). Many studies show no relationship between age and risk for complications (45,57,(60)(61)(62)(66)(67)(68)(69)(70)(71), while other studies show that elderly patients have more risk (44,53,63).…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 49%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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“…A prospective study by Woerdeman et al reported 400 implant only reconstructions following SSM, identifying patient related risk factors associated with complications. The study recommended particular caution in obese patients who smoke (32% loss of implant) and in large breasted women (27% loss of implant) [29]. In a separate study, the same authors found patient age and experience of the operating surgeon to be associated with a greater risk of post-operative complications [30].…”

Section: Prosthetic Implantsmentioning

confidence: 97%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection Criteria

Abstract: The clinically relevant increase of risk of implant loss should lead to reluctance to perform combined skin-sparing mastectomy and immediate prosthetic breast reconstruction in obese patients who smoke (32 percent loss) and in those with more than average sized breasts (27 percent loss).

Cited by 164 publications

References 21 publications

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

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