Plastic Surgery Research Council
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NIPPLE-AREOLAR COMPLEX NECROSIS AFTER NIPPLE SPARING MASTECTOMY WITH IMMEDIATE IMPLANT-BASED RECONSTRUCTION: RISK FACTORS AND THE SUCCESS OF CONSERVATIVE TREATMENT
Presenter: Kevin Small
Co-Authors: Dent B; Talmor M
New York Presbyterian Hospital Weill Cornell

Background: We report our senior author s experience with nipple-areolar complex (NAC) necrosis following nipple sparing mastectomy (NSM) performed through an inframammary fold (IMF) incision, her success with conservative treatment measures, and an analysis of patient risk factors for both NAC necrosis and conservative treatment failure.

Methods: A retrospective chart review was conducted on a prospectively-collected IRB-approved database of NSM cases performed through IMF incisions with immediate implant-based reconstruction between July 2006 and October 2011. Dressings consisted of topical nitroglycerin and anti-bacterial petrolatum gauze applied to the NAC for a week, a loose bra, and external warming for 24 hours. All cases of either partial- (PT) or full-thickness (FT) NAC necrosis were treated with bacitracin ointment. In cases of FT necrosis, tissue expanders were also deflated to 100 cc. Patients were followed for a year whenever possible and outcomes were reported.

Results: 139 women underwent 232 NSMs. PT and FT NAC necrosis occurred in 18.5% (n = 43) and 8.2% (n = 19), respectively. All PT necrosis cases and 16 FT necrosis cases resolved with conservative treatment; of these, 7 PT and 2 FT necrosis cases were left with areas of residual NAC depigmentation. Only 3 FT necrosis cases required operative debridement. Factors associated with NAC necrosis included older age (p = 0.0039), higher BMI (p = 0.0180), larger breast volume (p = 0.0465), a history of diabetes (p = 0.0125), and the use of acellular dermal matrix products (ADMs) (p = 0.0058). Factors associated with conservative treatment failure included older age (p = 0.0001), single-stage reconstruction (p = 0.0415), and ADM use (p = 0.0076).

Conclusion: NSM via an IMF incision followed by immediate implant-based reconstruction is a reasonable option for patients undergoing mastectomy. NAC necrosis can be effectively managed conservatively in order to preserve cosmesis and implant viability. Factors associated with both higher rates of NAC necrosis and failed conservative treatment included older age and ADM use.


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