Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Nipple-Sparing Mastectomy in Patients with Previous Breast Surgery: Comparative Analysis of 123 Immediate Reconstructions
Alex Lin, BS, Eric Liao, MD, Jonathan Winograd, MD, Curtis Cetrulo, MD, William G. Austen, Jr., MD, Amy S. Colwell, MD, Rong Tang, MD, Barbara L. Smith, MD, PhD.
MGH, Boston, MA, USA.

Purpose: An increasing number of women are candidates for nipple preservation with mastectomy. It is unclear how previous breast surgery impacts the ability to perform nipple-sparing mastectomy (NSM) and reconstruction.
Methods: Single institution retrospective review was performed between June 2007-December 2012.
Results: 104 patients with prior breast surgery (PBS) underwent 123 NSM with immediate reconstruction. The PBS included 105 lumpectomies, 14 breast augmentations, and 4 breast reductions. A group of 222 patients and 462 NSM reconstructions without prior breast surgery (no PBS) served as the control group. The group with PBS were older (49.6yrs vs. 45.4yrs, p<0.001) but had similar BMI and smoking status. PBS reconstructions were more often unilateral, therapeutic, and associated with preoperative radiotherapy (p<0.001 for each) (Table 1).
There were similar percentages of single-stage vs. two-stage reconstruction between the groups. The most frequent incision for PBS was use or extension of a pre-existing scar while the most frequent incision for no PBS was the inferolateral IMF incision (p<0.001).
There was no significant difference in total complications or individual complications of skin necrosis, nipple necrosis, or implant loss in the group with PBS compared to no PBS (p>0.2 for each). There was a trend toward increased risk of infection in the PBS reconstructions (5.69% vs. 2.38%, p=0.059).
When stratifying by type of prior breast surgery, the lumpectomy group had a higher number of patients with preoperative radiotherapy (31 vs. 11, p<0.05) and therapeutic mastectomy (76.2% vs. 40.7%, p<0.05). The breast augmentation patients had a higher number of single-stage reconstructions (92.9% vs. 61.5%, p<0.05) but also an increased risk of total complications (35.7% vs. 13.6%, p<0.05) and a trend toward increased mastectomy skin flap necrosis (14.3% vs. 3.90% p=0.112). There was a trend toward infection and implant loss (25.0% vs. 2.16% p=0.091) in patients with breast reduction (Table 2).
Conclusions: NSM and immediate reconstruction can be performed in patients with prior breast surgery with no significant increase in nipple loss. Larger series are warranted to determine if breast augmentation or breast reduction patients have higher rates of complications following mastectomy compared to patients without prior breast surgery.


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