Implant-sparing Mastectomy: An Alternative for Women Undergoing Mastectomy With Retropectoral Implants

Burke, Erin E.; Laronga, Christine; Sun, Weihong; DeBiase, Steven R.; Naqvi, Syeda Mahrukh Hussnain; Fridley, Brooke L.; Czerniecki, Brian J.; Hoover, Susan; Khakpour, Nazanin; Kiluk, John V.; Lee, Marie Catherine

doi:10.1016/j.clbc.2019.08.007

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…The 5-year recurrence rate among women who underwent SSM and NSM in our population was respectively 7.8% and 13.3%. Despite the high variability in median follow-up lengths, in the literature recurrence rate of SSM and NSM range respectively from 0% to 14.3% [15,[25][26][27][28][29][30][31][32][33][34][35][36] and from 0% to 10.3% [25,32,34,35,[37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques

Bertozzi,

Londero,

Seriau

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background:The introduction of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate reconstruction allowed a noticeable improvement in reconstructive surgery aesthetic results and patients' psychophysical well-being. In any case, there are still concerns about the long-term oncological safety of these two procedures. This study aims to assess the oncological outcomes of women who underwent SSM and NSM and to compare them with traditional modified total mastectomy (MTM). The secondary outcome was to compare mastectomy with breast-conserving surgery (BCS) outcome. Methods: We performed a retrospective chart review study concerning all patients who had experienced SSM and NSM in our Clinic between January 2004 and July 2013. The main outcomes were overall survival (OS), disease-free survival (DFS), and recurrences cumulative rate. Results: Among this study's 1836 invasive breast carcinomas, we found NSM (86.7, 95% confidence interval (CI), 76.7-98.0%) to have a significantly shorter 5-year DFS than MTM (90.4%, 95% CI, 87.9-93.0%). Furthermore, low body mass index (odds ratio (OR) 0.733, p = 0.056), basal-like molecular subtype (OR 28.932, p < 0.05), extended intraductal component (OR 11.160, p = 0.107), and lymph node metastasis extracapsular invasion (OR 8.727, p = 0.077) were the most significant predictors of recurrence in women treated with NSM. Furthermore, patients with BCS had significantly longer OS and DFS than those who underwent MTM. Conclusions: Occult nipple neoplastic involvement following negative intraoperative histological examination of subareolar tissue may explain the higher recurrence rate among women undergoing NSM. Patients with one or more risk factors for recurrence after NSM, such as basal-like molecular subtype, extended intraductal component, and extracapsular invasion of lymph node metastasis, should be given special attention.

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques

Bertozzi,

Londero,

Seriau

et al. 2023

Clin. Exp. Obstet. Gynecol.

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“…Given the variations in breast anatomy, patients have several options to consider when discussing surgical routes. The increasing rate of complications with SSM techniques can be attributed to the demanding nature of the procedure and the shift away from SSM unless necessary [ 6 , 7 ]. SSM and its variations, including NSM, are particularly challenging due to the need to preserve as much skin as possible [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review

Idris,

Ahmedfiqi,

Shebrain

et al. 2024

JCM

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Background: Research advancing effective treatments for breast cancer is crucial for eradicating the disease, reducing recurrence, and improving survival rates. Nipple-sparing mastectomy (NSM), a common method for treating breast cancer, often leads to complications requiring re-operation. Despite advancements, the use of hyperbaric oxygen therapy (HBOT) for treating these complications remains underexplored. Therefore, we analyze the efficacy of HBOT in the post-operative care of patients undergoing NSM. Methods: A systematic search was conducted using PubMed, Scopus, and the Cochrane Library. Studies were assessed for eligibility using the PICO (Population, Intervention, Comparison, Outcome) framework and classified based on American Society of Plastic Surgeons (ASPS) levels of evidence. Seven studies, totaling a pool of 63 female patients, met the inclusion criteria. Among these studies, four were categorized as Level III (57.1%), one as Level IV (14.3%), and two as Level V (28.6%). These studies focused on HBOT’s role in wound healing, the successful salvage of breast reconstruction, and the optimal timing for HBOT. Results: This review revealed that HBOT indeed has potential for improving tissue oxygenation, vascularization, and, consequently, wound healing. It is noted that HBOT is efficacious for mitigating post-NMS complications, including infections, re-operation, flap loss, seroma, and hematoma. Conclusions: Overall, HBOT could be beneficial in standard post-surgical care protocols for patients undergoing NSM due to its role in mitigating common adverse effects that occur after mastectomy. Despite promising outcomes, the recent literature lacks rigorous clinical trials and well-defined control groups, underscoring the need for further research to establish standardized HBOT protocols.

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Implant-Based Breast Reconstruction After Nipple-Sparing and Skin-Sparing Mastectomy in Breast-Augmented Patients: Prepectoral or Submuscular Direct-to-Implant Reconstruction?

Salgarello,

Fabbri,

Visconti

et al. 2023

Aesthetic Surgery Journal

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Background Patients with breast augmentation facing a breast cancer diagnosis pose unique challenges for both breast and plastic surgeons in terms of treatment and reconstruction. Traditional submuscular direct-to-implant (DTI) breast reconstruction is often considered the standard approach, regardless of the previous implant pocket. However, recent trends in prepectoral reconstruction provide an innovative solution for patients with prior subglandular and submuscular implants. Objectives This study aims to share our experiences with DTI breast reconstruction in patients with a history of breast augmentation, with a specific focus on the viability of prepectoral reconstruction. Methods A retrospective review was conducted on 38 patients with prior breast augmentation who underwent either skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) for breast cancer, followed by DTI reconstruction between January 2015 and July 2023. Our analysis considered various factors, including previous implant positioning, capsular and implant status, and mastectomy flap thickness (MFT), offering insights into the rationale behind choosing the new implant positioning. Results Patients with a history of subglandular breast augmentation and an MFT greater than 1 cm were candidates for prepectoral reconstruction. When MFT was less than 1 cm but flap vascularity was sufficient, a prepectoral reconstruction was performed; otherwise, retropectoral reconstruction was preferred. Patients with submuscular breast augmentation were evaluated similarly, with submuscular reconstruction chosen when MFT was less than 1 cm and prepectoral reconstruction preferred when MFT exceeded 1 cm. Conclusions Immediate prepectoral DTI reconstruction represents a feasible option for specific patients with a history of breast augmentation. Decisions regarding the reconstructive approach are influenced by variables such as mastectomy flap thickness, implant status, and capsular conditions.

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Implant-sparing Mastectomy: An Alternative for Women Undergoing Mastectomy With Retropectoral Implants

Cited by 3 publications

References 18 publications

Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques

Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques

Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review

Implant-Based Breast Reconstruction After Nipple-Sparing and Skin-Sparing Mastectomy in Breast-Augmented Patients: Prepectoral or Submuscular Direct-to-Implant Reconstruction?

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