Nipple-Sparing Mastectomy via an Inframammary Fold Incision for Patients With Scarring From Prior Lumpectomy

Huston, Tara L.; Small, Kevin; Swistel, Alexander; Dent, Briar L.; Talmor, Mia

doi:10.1097/sap.0000000000000004

Cited by 21 publications

(29 citation statements)

References 9 publications

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“…In an evaluation of NSM via IMF in patients with previous lumpectomy, Huston et al (2015) demonstrated an overall rate of 20.4% NAC ischemia. Conversely, they found no significant correlation between the incidence of NAC ischemia and various demographic and clinical factors including age, BMI, resection volume, prior radiation, ADM use, diabetes, or smoking history.…”

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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Section: Discussionmentioning

confidence: 99%

Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

Mahmood¹,

Suber²,

Zadikany³

et al. 2016

CCO

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“…This incision may be better for patients with smaller, less ptotic breasts, as those with larger, more ptotic breasts are at an increased risk for nipple malposition [29]. However, surgeons have reported successful results in patients with medium and large breasts with more ptosis [27].…”

Section: Inframammary Fold Incisionmentioning

confidence: 99%

“…The incision leaves no visible scar on the anterior surface of the breast mound, hiding it within the natural crease of the breast, all while providing great exposure for tumor resection. Also, there is decreased risk of lateralization of the nipple with the use [29], and it can be used for any future breast surgeries if the inferior skin is conserved.…”

Section: Inframammary Fold Incisionmentioning

confidence: 99%

Microsurgical Flaps in Nipple Sparing Mastectomy: Surgical Techniques and Aesthetic Principles

Azadgoli¹,

Gould²,

Patel³

2018

IMJ

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“…The emerging trend, especially in prophylactic mastectomies is to retain native nipple and areolar tissue 26 with intraoperative sampling of subareolar region to ensure absence of malignant cells. 27 The clinical rationale for keeping native tissue relates to the easy palpation of potential abnormalities in the periareolar region, with visual review of long-term imaging of the nipple/areolar complex. 26 Prophylactic contralateral mastectomy is a common request from patients who require a mastectomy on the affected side, or in lieu of breastconserving surgery.…”

Section: Prophylactic Mastectomymentioning

confidence: 99%

“…Skin-sparing mastectomy is common, especially if immediate or delayed reconstructive surgery is planned. 27 Negative suction devices are inserted at wound closure to drain excess serosanguinous fluids. Drains remain until the 24-hour output is approaching 30 cc or less.…”

Section: Mastectomymentioning

confidence: 99%