Nipple-Sparing Mastectomy in Patients with Previous Breast Surgery

Frederick, Michael J.; Lin, A. T.; Neuman, Robert C.; Smith, Barbara L.; Austen, William G.; Colwell, Amy S.

doi:10.1097/prs.0000000000001283

Cited by 50 publications

(20 citation statements)

References 5 publications

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“…Concerns are mostly related to increased early postoperative complications such as infection, wound healing problems, and ischemia or necrosis of the skin or NAC [18,19,20]. Age, skin incision, flap thickness, reconstruction type, smoking, neoadjuvant chemotherapy, preoperative irradiation, and comorbidities have been reported as risk factors for ischemic complications concerning the skin and NAC [1,2,3,4,18,19,21,22,23,24,25,26]. Patients with an increased BMI and DM are likely to have additional complications due to associated vascular disease [25].…”

Section: Discussionmentioning

confidence: 99%

“…Nipple-sparing mastectomy (NSM) has been proven to be an oncologically safe procedure in breast cancer surgery [1,2,3,4]. With primary implant reconstruction, NSM has become the best treatment option for women requiring mastectomy due to better cosmetic result, greater satisfaction, and better quality of life compared to modified radical mastectomy or skin-sparing mastectomy [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

et al. 2018

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Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m², and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

et al. 2018

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“…In the study by Frederick et al (17), the IBR rate after mastectomy for ILBLR was 60%. Our rate of 32.8% reflects careful patient selection to achieve a high success rate and reasonably low complication rate.…”

Section: Discussionmentioning

confidence: 93%

Types of Mastectomies and Immediate Reconstructions for Ipsilateral Breast Local Recurrences

et al. 2020

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Purpose: Ipsilateral-breast-local-recurrence (ILBLR) is a rare event with little data on immediate-breast-reconstruction (IBR). We report post-operative results of different types of mastectomy for ILBLR with or without IBR performed during a period of 40 months in order to analyze post-operative complications as main objective.Methods: We analyzed mastectomies performed for ILBLR after initial breast conservative treatment from January 2016 to April 2019. The characteristics of patients, surgery, complication rate, postoperative hospitalization have been determined.Results: Of the 207 mastectomies, 32.8% had an IBR: 31 nipple-sparing-mastectomy (NSM) and 37 skin-sparing-mastectomy (SSM) with 37 latissimus-dorsi-flap (LDF) IBR and 31 implant-IBR. Few reconstruction was performed for patients with body-mass-index ≥30 (OR = 0.214), infiltrating ductal carcinomas (OR = 0.272) and ASA-3 patients (OR = 0.254). In multivariate analysis, LDF-IBR was more often realized for NSM and for patients with BMI ≥25. The overall complication rate was 37.4%: 45.6 and 33.1% with and without IBR, respectively (p = 0.056). In multivariate analysis, BMI ≥25 (OR 2.02, p = 0.023), IBR (OR 1.9, p = 0.046) and tobacco (OR 2.17, p = 0.055) were correlated with higher risk of complications. There was no difference for Grade 2–3 complications rates for IBR and no IBR, respectively (14.7%: 10/68 and 9.3%: 13/139). In multivariate analysis, overall survival from date of mastectomy for local recurrence was significantly associated with interval time to local recurrence (OR 6.981).Conclusion: Salvage mastectomy and IBR is a good choice for ILBLR, particularly using flap reconstruction. NSM can be considered as a good option in selected patients for ILBLR for NSM and/or LDFR.

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“…In our series, nipple-areola-sparing mastectomy followed a quadrantectomy for breast cancer in the vast majority of cases, as expected in a cancer center, and followed aesthetic breast surgery (mastopexy, breast augmentation, or reduction mammaplasty) in only a few patients. In 2015, Frederick et al 15 reported a smaller cohort of patients including 187 nipple-sparing mastectomies in 160 women after previous breast surgery (154 lumpectomies, 27 breast augmentations, and six reduction mammaplasties): no significant differences in total complications, ischemic complications, nipple loss, or implant loss were associated with prior breast surgery compared to a cohort of patients with no previous surgery. However, the article focused on reconstruction and complications, and oncologic outcomes were not reported.…”

Section: Discussionmentioning

confidence: 99%

Is Nipple-Sparing Mastectomy Indicated after Previous Breast Surgery? A Series of 387 Institutional Cases

Vicini¹,

Lorenzi²,

Invento³

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Nipple-sparing mastectomy is now routinely performed 1-3 for primary invasive and in situ breast cancer when breast-conserving surgery is not indicated, even after neoadjuvant treatments. 4,5 Nevertheless, it is still contraindicated for T4 neoplasms, 6 cancer involving the retroareolar tissue, microcalcifications close to the subareolar region, malignant nipple discharge, or Paget disease. Nipple-sparing mastectomy is also performed in high-risk healthy patients 1 for riskreducing surgery. Different patterns of skin incision are described according to tumor location, breast volume, shape, and ptosis. 7,8 This surgical approach can even be used after breast conservation in case of positive margins, in

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Nipple-Sparing Mastectomy in Patients with Previous Breast Surgery

Abstract: Therapeutic, III.

Cited by 50 publications

References 5 publications

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

Types of Mastectomies and Immediate Reconstructions for Ipsilateral Breast Local Recurrences

Is Nipple-Sparing Mastectomy Indicated after Previous Breast Surgery? A Series of 387 Institutional Cases

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