Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique

Abstract

Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple–areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients’ cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR.

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

“…The study aims to evaluate the early outcomes after SSM and /or SNSM for BC or diagnosis of BRCA1/2 mutation followed by breast reconstruction with one- or two-stage technique. Clinical studies have demonstrated that performing immediate implant-based breast reconstruction after SSM and /or SNSM does not impact on post-operative recurrence, survival, or delayed diagnosis of recurrence [ 4 , 5 , 7 ].…”

“…The explanation could probably be linked to the surgical complexity correlated to preserve an adequate thickness of subcutaneous flap due to previous breast scar. Moreover, patients with ipsilateral loco-regional recurrence after BCS plus radiotherapy are at higher risk of complications if underwent SSM and/or SNSM and immediate direct-to-implant technique [ 7 , 28 ].…”

“…Currently, breast reconstructive techniques are divided into autologous reconstruction with flaps [transverse rectus abdominis (TRAM), deep inferior epigastric perforators (DIEP), and others] and heterologous reconstruction (prosthesis-based techniques), in one or in two stages [ 2 – 5 ]. An implant-based breast reconstruction method is used after approximatively 80% of mastectomies [ 7 ]. The SSM and/or SNSM preserves the natural skip flap and adequate volume, allowing one-stage technique by immediate reconstruction with permanent breast implant; the implant is usually enclosed by an acellular dermal matrix, in a prepectoral pocket [ 2 – 5 , 8 – 15 ].…”

Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion in Nipple/Skin-Sparing and Skin-Reducing Mastectomies with Implant-Based Breast Reconstruction

“…Mastectomy techniques are so improved to allow the skin and NAC preservation with the same oncological safety of simple mastectomies, where skin and NAC are removed [ 7 , 8 ]. Moreover, the postoperative complication rate of skin and NAC-sparing mastectomies is around 20–30%, needing a medical or surgical treatment in 10–12% of cases [ 9 ]. The most frequent complications are mastectomy skin flaps (MSF) necrosis, surgical site infection (SSI), the presence of a seroma and/or hematoma, and the implant removal, determining a reconstructive failure [ 10 ].…”