Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Outcomes of Total Skin-Sparing Mastectomy and Reconstruction in 924 Breasts Over 11 Years
Frederick Wang, MD, Anne Peled, MD, Robert Foster, MD, Eric Wang, MD, Cheryl Ewing, MD, Michael Alvarado, MD, Laura Esserman, MD, MBA, Hani Sbitany, MD.
University of California, San Francisco, San Francisco, CA, USA.

PURPOSE:
Total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex (NAC) has become increasingly accepted and offered to women for both therapeutic and prophylactic indications.
METHODS:
This retrospective study from October 2001 to January 2013 evaluates the outcomes of 599 patients who underwent TSSM for both therapeutic and prophylactic indications. Postoperative complications and recurrences were obtained from a prospectively maintained database. Outcome measures included postoperative infections, ischemic skin and nipple necrosis, implant loss, and tumor recurrence.
RESULTS:
TSSM was performed on 924 breasts with a mean follow-up time of 24 months. The mean age was 47±10 years with a range of 18-74 years. TSSM was performed prophylactically in 320 cases (34.6%). Tissue expander and implant based reconstruction was performed in 813 cases (87.9%) while autologous reconstruction was performed in the remaining 111 cases (12.1%). A total of 195 patients (32.6%) received neoadjuvant chemotherapy and 99 patients (16.5%) received adjuvant chemotherapy. Post mastectomy radiation therapy was performed in 114 breasts (12.3%). Ischemic complications included 19 cases (2.1%) of nipple necrosis and 98 cases (10.6%) of skin flap necrosis. A total of 69 expanders/implants were removed secondary to infection (8.5%). Factors contributing to postoperative infections included radiation therapy (RR 2.27, p<0.001), smoking history (RR 1.53, p<0.01), and undergoing chemotherapy (RR 1.37, p<0.03). Factors contributing to loss of expanders/implants included radiation therapy (RR 3.76, p<0.001), diabetes (RR 3.45, p=0.02), and smoking history (RR 1.81, p=0.018). Overall locoregional recurrence rate was 1.5% and distant recurrences occurred in 1.3% of breasts.
CONCLUSION:
In this large cohort of patients with breast cancer, TSSM was associated with a low rate of ischemic complications and recurrences. In addition, smoking history, diabetes, chemotherapy, and radiation therapy were all associated with an increased risk of postoperative complications.


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