The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction

Rawlani, Vinay; Fiuk, Julia

doi:10.4172/plastic-surgery.1000717

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…Seventy-three studies 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 reported LR rates, complication rates, and/or nipple necrosis rate following NSM. Table 1 presents the number of patients, the number of procedures, the LR rate, the complication rate, and the nipple necrosis rate.…”

Section: Resultsmentioning

confidence: 99%

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

2016

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Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4–156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.

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Section: Resultsmentioning

confidence: 99%

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

2016

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“…Based on the literature and our experience, we recommend routine use of an inframammary incision, as peri-areolar incisions have been shown to have increased rates of nipple necrosis . 13 In our limited experience, attempts at NSM by dismantling the vertical limb of the previous Wise-pattern has shown worse wound-related complications, including NAC necrosis and, therefore, has been abandoned. We describe the use of an inferiorly-based pedicle at the time of oncoplastic breast reduction, and despite division of the pedicle at the time of NSM, there were no cases of nipple loss, suggesting that an inferiorly based pedicle is safe.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Nipple-sparing Mastectomy with Reconstruction after Recent Oncoplastic Wise-pattern Reduction

Choudhry

Martin

Holton

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: For patients with large and/or ptotic breasts, a planned staged approach to nipple-sparing mastectomy (NSM) has been described. Less is known about surgical outcomes of unplanned staged NSM for management of positive margins after partial mastectomy with oncoplastic reduction. It is not clear from earlier studies whether an interval of less than 10 weeks between oncoplastic reduction and NSM is feasible, when a shorter interval is important for oncologic reasons. Methods: This is a single institution analysis of patients from 2018 to 2021 with a diagnosis of invasive cancer or ductal carcinoma in situ who underwent NSM after oncoplastic breast reduction for positive margins or nodes. The primary endpoint measured was nipple loss. Secondary outcomes were need for operative re-intervention and wound complications. Results: Nine patients (14 breasts) underwent partial mastectomy with oncoplastic Wise-pattern breast reduction, followed by NSM. Three patients underwent intersurgery chemotherapy. The average interval between oncoplastic reduction and NSM was 11.3 weeks when excluding patients undergoing chemotherapy (range 8-13 weeks). Thirteen breasts (93%) underwent pre-pectoral direct-to-implant reconstruction. One breast (7%) received autologous reconstruction. One breast required reoperation for seroma. The rate of partial or total nipple loss was 0%, with an average follow-up of 1.6 years. Conclusions: Our experience demonstrates excellent outcomes from NSM after oncoplastic breast reduction, with the majority of patients undergoing single-stage pectoral direct-to-implant breast reconstruction. Overall, patients had a shorter intersurgery interval, compared with prior studies, with no cases of nipple loss. An intersurgery interval of 8 weeks may be feasible when avoiding delays is important for oncologic reasons.

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“…Rawlani et al, [33] reported in their study that a higher rate of nipple necrosis was associated with the periareolar incision than using the lateral or inframammary incision in NSM. Regarding the current study, medial breast incisions were avoided instead lateral or lateral inframammary incision were used in NSM.…”

Section: Discussionmentioning

confidence: 94%

Post Nipple-Sparing Mastectomy Reconstruction: Renewed Popularity of Latissimus Dorsi Flap for More Cosmetically Appealing Results

Wahsh

2018

The Egyptian Journal of Plastic and Reconstructive Surgery

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Background: Breast reconstruction became a dynamic continually progressing group of procedures. These procedures are aiming to provide the patients after mastectomy more symmetrical and an aesthetically pleasing recreated breast in the cases which are fulfilling multiple basic oncologic goals. The reconstruction must not impede the oncological safety or cause a delay in detection of local recurrence or adjuvant cancer management. The aim of the current study is to evaluate the surgical outcomes of the immediate breast reconstruction by latissimus dorsi flap in patients after nipple sparing mastectomy regarding the aesthetic results, post-operative complications and patient satisfaction.Patients and Methods: Eight consecutive patients having invasive breast cancer (7 patient have invasive duct carcinoma and a patient has invasive lobular carcinoma) underwent nipple sparing mastectomy. All patients had immediate breast reconstruction by latissimus dorsi flap at Zagazig University hospitals within three years. Surgical outcomes in terms of post-operative complications including hematoma, wound infection, scarring, dorsal seroma, skin necrosis, back pain, and aesthetic outcomes such as breast symmetry, visual difference of bilateral breasts, breast contour, and nipple cosmoses were assessed.Results: Surgical outcomes including post-operative complications; hematoma, wound infection were not detected. Marked back scarring (25%), dorsal seroma (12.5%) were reported. Aesthetic outcomes were satisfactory and 75% of patients reported excellent satisfaction with (2 cases) 25% were not satisfied due to the back scar or volume asymmetry.Conclusion: Following nipple sparing mastectomy, purely autogenous immediate breast reconstruction by latissimus dorsi flap is a valuable reconstructing technique in selected type of patients. It has low incidence of complications, considerable aesthetic outcomes with high patient satisfaction relieving the psychological postmastectomy trauma.

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The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction

Cited by 17 publications

References 22 publications

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

Outcomes of Nipple-sparing Mastectomy with Reconstruction after Recent Oncoplastic Wise-pattern Reduction

Post Nipple-Sparing Mastectomy Reconstruction: Renewed Popularity of Latissimus Dorsi Flap for More Cosmetically Appealing Results

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