Nipple-Sparing Mastectomy for Prophylactic and Therapeutic Indications

Spear, Scott L.; Willey, Shawna C.; Feldman, Elizabeth; Cocilovo, Costanza; Sidawy, Mary K.; Al-Attar, Ali; Hannan, Catherine; Seiboth, Laura; Nahabedian, Maurice Y.

doi:10.1097/prs.0b013e31822b6456

Cited by 181 publications

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“…Although nipple-areola-sparing mastectomy has not been shown to be associated with increased infectious complications, the incidence reported in the literature is as high as 17.8 percent, which is significantly higher than our reported incidence. [26][27][28] Third, when comparing the ready-to-use acellular dermal matrix cohort to the submuscular cohort, breasts were more likely to have greater mean tissue expander size (439.88 ± 117.14 ml versus 396.63 ± 113.41 ml; p = 0.0020), greater mean tissue expander fill (205.99 ± with the submuscular cohort. This, given the clear indications for acellular dermal matrix use in the study, is understandable.…”

Section: Discussionmentioning

confidence: 99%

Sterile “Ready-to-Use” AlloDerm Decreases Postoperative Infectious Complications in Patients Undergoing Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Weichman

Wilson

Saadeh

et al. 2013

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

Sterile “Ready-to-Use” AlloDerm Decreases Postoperative Infectious Complications in Patients Undergoing Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Weichman

Wilson

Saadeh

et al. 2013

Plastic and Reconstructive Surgery

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“…August 10, 2014|Volume 5|Issue 3| WJCO|www.wjgnet.com Petit et al [109] 2009 1001 35 55 Nahabedian et al [17] 2006 11 0 1 Spear et al [108] 2011 49 3 3 Voltura et al [50] 2008 51 0 0 De Alcantara Filho et al [23] 2011 341 0 1 Wijayanayagam et al [71] 2008 64 3 10 Jensen et al [27] 2011 127 0 8 Paepke et al [103] 2009 109 1 23 Babiera et al [107] 2010 54 0 4 Munhoz et al [33] 2013 158 1 8…”

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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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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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“…We used the following key terms to search all databases: nipple-sparing mastectomy, inframammary fold, immediate reconstruction, skin flap necrosis, nipple necrosis, and reconstructive criteria. The literature reflects a wide range of nipple-areolar complex necrosis rates between 0-48% (Salgarello et al, 2010;Rusby, Smith, & Gui, 2010 Sacchini et al, 2006;Spear et al, 2011;Djohan et al, 2010;Crowe et al, 2004;Colwell et al, 2014;Salibian, Harness, & Mowlds, 2013;Endara, Chen, Verma, Nahabedian, & Spear, 2013 reconstruction, Gould et al (2013) found that their overall incidence of any (partial or total) nipple necrosis was 20% via a non-IMF approach. In a review of 64 NSM via various approaches, Wijayanayagam et al noted a total NAC necrosis rate of 20%, partial NAC necrosis 84%, and total skin-sparing skin flap necrosis of 17%.…”

Section: Discussionmentioning

confidence: 99%

Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

Mahmood¹,

Suber²,

Zadikany³

et al. 2016

CCO

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Background: Nipple-sparing mastectomy (NSM) is a technically feasible and oncologically sound option for patients who meet eligibility criteria. Inframammary fold (IMF) incision results in a well-hidden scar and enhanced final aesthetic result. While oncologic eligibility criteria have been well established, reconstructive criteria are less defined. We report Moffitt Cancer Center's (MCC) outcomes with IMF incision for NSM and immediate reconstruction, and factors associated with increased complication rate.Methods: IRB approved retrospective cohort study of patients who underwent NSM through an IMF approach with immediate reconstruction at MCC from 2006-2013 was conducted. Analysis included patient demographics, tumor characteristics, ancillary treatment, reconstructive method, and nipple and skin flap necrosis. A literature review was performed to compare outcomes with other types of incisions.Results: 115 patients met inclusion criteria, representing 199 breasts. The average age was 48.1 (range 18-74). The two main complication categories evaluated were nipple necrosis (8%) and skin flap necrosis (10.6%). Older age demonstrated a significant relationship with skin flap necrosis (p=0.0155) and overall complications (p=0.0492). Complication rate was significantly higher in the cancer side vs. prophylactic side in patients who underwent bilateral mastectomies (p=0.0088). Factors with trends related to increased skin flap necrosis included increased mastectomy specimen weight (p=0.0704), smoking (p=0.0726), and significant comorbidities (p=0.0665).Conclusion: Our institution's results substantiate that NSM through an IMF approach with immediate reconstruction is a viable option. Recognized risk factors such as age, laterality, breast weight, smoking history, and comorbidities associated with increased complications should be considered when determining patient selection for reconstruction.

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Nipple-Sparing Mastectomy for Prophylactic and Therapeutic Indications

Abstract: Therapeutic, IV.

Cited by 181 publications

References 0 publications

Sterile “Ready-to-Use” AlloDerm Decreases Postoperative Infectious Complications in Patients Undergoing Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Sterile “Ready-to-Use” AlloDerm Decreases Postoperative Infectious Complications in Patients Undergoing Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix

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

Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

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