Buried Flap Reconstruction after Nipple-Sparing Mastectomy

Levine, Steven M.; Snider, Chelsea C.; Gerald, Grace; Tanna, Neil; Broer, P. Niclas; Stolier, Alan; Sadeghi, Ali; Allen, Robert J.

doi:10.1097/prs.0b013e3182a00e79

Cited by 30 publications

(14 citation statements)

References 46 publications

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“…The introduction of skin-sparing and nipple-sparing mastectomy has allowed immediate breast reconstruction to gain momentum [27]. Here, the native breast skin envelope remains intact, which facilitates good aesthetic results, especially for microvascular autologous tissue-based reconstructions [28][29][30]. Psychologically, patients receiving IBR show less anxiety or depression and higher levels of self-esteem, sexuality and an increased quality of life [4,31,32].…”

Section: Discussionmentioning

confidence: 99%

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Prantl

Moellhoff

Fritschen

et al. 2020

Arch Gynecol Obstet

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Purpose Immediate breast reconstruction (IBR) at the time of mastectomy is gaining popularity, as studies show no negative impact on recurrence or patient survival, but better aesthetic outcome, less psychological distress and lower treatment costs. Using the largest database available in Europe, the presented study compared outcomes and complications of IBR vs. delayed breast reconstruction (DBR). Methods 3926 female patients underwent 4577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups according to the time of reconstruction: an IBR and a DBR group. Surgical complications were accounted for and the groups were then compared. Results Overall, the rate of partial-(1.0 versus 1.2 percent of cases; p = 0.706) and total flap loss (2.3 versus 1.9 percent of cases; p = 0.516) showed no significant difference between the groups. The rate of revision surgery was slightly, but significantly lower in the IBR group (7.7 versus 9.8 percent; p = 0.039). Postoperative mobilization was commenced significantly earlier in the IBR group (mobilization on postoperative day 1: 82.1 versus 68.7 percent; p < 0.001), and concordantly the mean length of hospital stay was significantly shorter (7.3 (SD3.7) versus 8.9 (SD13.0) days; p < 0.001). Conclusion IBR is feasible and cannot be considered a risk factor for complications or flap outcome. Our results support the current trend towards an increasing number of IBR. Especially in times of economic pressure in health care, the importance of a decrease of hospitalization cannot be overemphasized.

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Section: Discussionmentioning

confidence: 99%

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Prantl

Moellhoff

Fritschen

et al. 2020

Arch Gynecol Obstet

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“…Prior studies have reported infection rates of 1.5% to 17.8% 14–16,18 after NSM with tissue expander placement, and implant loss rates as high as 9.9% 14 . Breast infection rates ranging from 1.9% to 7.4% have been reported after autologous reconstruction 12,19 . One prior study found increased rates of infections requiring PO antibiotics with immediate tissue expander reconstruction compared with immediate autologous reconstruction, but this prior study did not find increased rates of infections requiring IV antibiotics with tissue expander reconstruction 12 .…”

Section: Discussionmentioning

confidence: 92%

Immediate Versus Delayed-Immediate Autologous Breast Reconstruction After Nipple-Sparing Mastectomy

et al. 2023

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IntroductionAutologous reconstruction following nipple-sparing mastectomy (NSM) is either performed in a delayed-immediate fashion, with a tissue expander placed initially at the time of mastectomy and autologous reconstruction performed later, or immediately at the time of NSM. It has not been determined which method of reconstruction leads to more favorable patient outcomes and lower complication rates.MethodsWe performed a retrospective chart review of all patients who underwent autologous abdomen-based free flap breast reconstruction after NSM between January 2004 and September 2021. Patients were stratified into 2 groups by timing of reconstruction (immediate and delayed-immediate). All surgical complications were analyzed.ResultsOne hundred one patients (151 breasts) underwent NSM followed by autologous abdomen-based free flap breast reconstruction during the defined time period. Fifty-nine patients (89 breasts) underwent immediate reconstruction, whereas 42 patients (62 breasts) underwent delayed-immediate reconstruction. Considering only the autologous stage of reconstruction in both groups, the immediate reconstruction group experienced significantly more delayed wound healing, wounds requiring reoperation, mastectomy skin flap necrosis, and nipple-areolar complex necrosis. Analysis of cumulative complications from all reconstructive surgeries revealed that the immediate reconstruction group still experienced significantly greater cumulative rates of mastectomy skin flap necrosis. However, the delayed-immediate reconstruction group experienced significantly greater cumulative rates of readmission, any infection, infection requiring PO antibiotics, and infection requiring IV antibiotics.ConclusionsImmediate autologous breast reconstruction after NSM alleviates many issues seen with tissue expanders and delayed autologous reconstruction. Although mastectomy skin flap necrosis occurs at a significantly greater rate after immediate autologous reconstruction, it can often be managed conservatively.

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“…As we previously advocated that surgical treatment of breast cancer has entered a scarless era, efforts were made in forgoing the skin paddles during ms-TRAM/DIEP breast reconstruction, so as to minimize the surgical scar and improve the cosmetic outcome [9]. Levine et al reported that placing an implantable doppler around the site of anastomosis was su cient for post-operative surveillance of the buried DIEP ap and forgoing of the skin paddles was feasible [10]. However, the implantable doppler was not easily accessible.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience

Zhu

Chen

et al. 2023

Preprint

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Background Nipple-sparing mastectomy in combination with buried abdominal free flap breast reconstruction without leaving any skin paddles for post-operative monitoring might be associated with better cosmetic outcomes. The feasibility of this approach remains unclear while a detailed and validated protocol of post-operative flap monitoring is lacking. Materials and Methods Eligible patients receiving abdominal free-flap breast reconstruction between 2015 and 2020 in our institution were included. Patients were categorized into the buried-flap cohort and the skin-paddle cohort based on whether a skin paddle remained for direct visual monitoring post-operatively. We reported the learning curve of this surgery and the determinants of operative and/or ischemic time. The oncological outcomes and surgical complications rates were also analyzed. Results This study included 147 eligible patients (buried-flap cohort: N = 18; skin-paddle cohort: N = 129). In early-stage patients with immediate breast reconstruction (N = 104), there were no observed relapse events with a median follow-up time of 18 months. The learning curve analysis showed significant reduction of the surgery time and the ischemic time with accumulation of surgical experience after 30 cases. The surgery time and ischemic time were significantly shorter in the buried flap cohort, when compared to that of the skin-paddle cohort. The take-back surgery rates, flap failure rates, and other complication rates were similar between two cohorts under the intra- and post-operative monitoring protocol. Conclusion This study supported the feasibility of autologous abdominal free-flap breast reconstruction using the buried flap approach, and we validated our intra- and post-operative monitoring protocol. A multicenter and prospective study is needed to validate this approach. Trial registration：NCT05560633

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Buried Flap Reconstruction after Nipple-Sparing Mastectomy

Abstract: Therapeutic, IV.

Cited by 30 publications

References 46 publications

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Immediate Versus Delayed-Immediate Autologous Breast Reconstruction After Nipple-Sparing Mastectomy

The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience

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