Breast cancer patient’s postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience

Abstract

Background: The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related QoL and patient’s satisfaction in patients undergoing NSM and breast reconstruction with or without ADM Methods: Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with definitive breast implant and ADM (Group A), IBR only with definitive breast implant (Group B), and two-stage breast reconstruction (Group C). The postoperative complications and BREAST-Q outcomes were compared. Results: A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8% in Group A, 3% in Group B and 6% in Group C. Postoperative infection occurred in two patients of Group A (5,5%), one patient of Group B (3%) and one of Group C (3%). Group A patients reported larger drain volume (1125 ± 243.5 cc), longer drain period (13.2 ± 2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥50 years presented a higher score in “Satisfaction with breast” (beta:5.198; p<0.001) and “satisfaction with outcome” domains (beta:5.421; p<0.05). Performing a bilateral breast reconstruction was associated to higher scores in “Physical Wellbeing Chest domain” (beta:3.278; p<0.05). In addition patients in Group A and Group B reported higher score in “Satisfaction with the breast” domain (p<0.001) but only in Group B we reported a higher score in “Satisfaction with outcome” (p<0.001). Conclusion: Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The pre pectoral placement of ADM could minimize complications and optimize aesthetic results.