Skin-Sparing Mastectomy with Immediate Breast and Nipple Reconstruction: A New Technique of Nipple Reconstruction

Abstract

Background. Most women with breast cancer today can be managed with breast conservation; however, some women still require mastectomy for treatment of their disease. Skin-sparing mastectomy (SSM) with immediate reconstruction has emerged as a favorable option for many of these patients. The authors combined the SSM technique with the preservation of a small part of the areola with immediate nipple together with with breast reconstruction. Methods. In an 8-year-period 155 female patients (age: 20–52 years old; mean age: 37.5 years) with extensive ductal intraepithelial neoplasia (DIN) or invasive breast cancer were treated with areola skin sparing mastectomy with immediate nipple and breast reconstruction. Patients were followed up prospectively by the breast surgeon, the plastic surgeon, and the oncologist for complications and recurrence. Results. After treatment, only 2 cases (1.29%) had a local recurrence. 8 out of 155 (5.5%) patients developed early complications (infections, seroma, haematoma), and 5 out of 155 patients (3.22%) developed delayed complications (implant rotation, aestethic deterioration) in the post operative time period. The final aesthetic outcome was judged as positive in 150 out of 155 patients (96.78%). Conclusion. In our experience, immediate nipple reconstruction after skin-sparing mastectomy is a technically feasible procedure which can give excellent cosmetic results.

Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction—A systematic review and meta‐analysis

“…Quantitative synthesis included 37 studies 4,8,9,11,13,19,[21][22][23][24][25][26][27][28][29][30][39][40][41][42][43][44][45][46][47][50][51][52]56,58,59,[62][63][64][65]67,68 on autologous PMBR (Figs. 2A-E; Table S3a) and 28 studies 20,[31][32][33][34][35][36][37][38][41][42][43][46]…”

“…In total, 22 studies [31][32][33][34][35][36][37][38]42,[47][48][49]54,55,57,[59][60][61]64,[66][67][68] reported local recurrence after immediate implant-based post-mastectomy breast reconstruction (I-IBR) (Fig. 3A, I 2 = 42.1% [95% CI, 3.8%-65.1%]).…”

Total Single-Stage Breast Reconstruction with Free Nipple Grafts Using the Salvage of Parts Concept

“…Nipple-sparing mastectomy (NSM) is normally defined as SSM along with preservation of the nipple-areolar complex. 2 SSM is usually described as the procedure of mastectomy, either simple or modified radical, with minimal skin excision. SSM involves excision of the whole of the breast tissue including the nipple-areolar complex while sparing or preserving the breast skin envelope.…”

“…Serra et al 2 recently demonstrated extensive ductal intraepithelial neoplasia or invasive breast cancer treated with areola SSM with immediate nipple and breast reconstruction is technically feasible and provide excellent cosmetic results. If we can fully reconstruct breasts in one stage, there is significant benefit.…”

Local and Locoregional Disease Free Survival in Patients Receiving NSM or SSM Compared with Conventional Mastectomy

“…pioneered. These techniques include: skin-sparing mastectomy (SSM) where the breast tissue and the nipple areolar complex (NAC) are removed but the skin overlying the breast is preserved, and the nipple sparing mastectomy (NSM), where the skin and NAC are preserved [3,[5][6][7][8] . Preserving the skin in an SSM and the preservation of the NAC in the NSM results in better cosmesis, improved patient satisfaction, and quality of life [3,5,8,9] .…”