Plastic Surgery Research Council
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Presenter: Amy S Colwell, MD
Co-Authors: Tessler O; Lin AM; Liao E; Winograd J; Cetrulo CL; Tang R; Smith BL; Austen WG
Harvard Medical School/ MA General Hospital

INTRODUCTION: Nipple-sparing mastectomy (NSM) is increasingly used for treatment and prevention of breast cancer. A growing body of oncologic literature supports the safety and efficacy of this procedure. We review breast reconstruction outcomes over a five-year period.

METHODS: Single institution retrospective review was performed between June 2007-2012 for nipple-sparing mastectomy procedures and immediate or delayed reconstruction. Data was collected on patient demographics, reconstruction modality, and complications.

RESULTS: Two hundred eighty-five patients with an average age of 40 years (range 25-78) underwent 500 nipple-sparing mastectomy procedures for breast cancer treatment (47%) or risk reduction (53%) Figure1. The average BMI was 23.6. Procedures were performed utilizing inferolateral inframammary fold (52%), superior or inferior periareolar (23%), lateral radial (10%), inferior radial (4%), or pre-existing scar (11%) incisions. Immediate breast reconstruction (n= 494, reconstruction rate 98.8%) was performed with direct-to-implant (60%), tissue expander-implant (38%), or autologous (2%) reconstruction procedures. One reconstruction was delayed and 3 patients (5 breasts) declined reconstruction. Forty reconstructions had prior therapeutic radiation and 39 received postoperative radiation to the tissue expander (n=15), implant (n=23), or flap (n=1). Complications included infection (3.2%), skin necrosis (7.1%), nipple necrosis (3.4%), and hematoma (1.2%) leading to implant loss in 19 (3.8%) reconstructions. The nipple areolar complex was partially or totally removed in 8% reconstructions due to ischemia (42.5%), a positive cancer margin (42.5%), or for symmetry (15%).

CONCLUSION: Nipple-sparing mastectomy procedures have a high immediate reconstruction rate and a low number of complications. Analysis will be performed to assess correlation of incisions, reconstructions, and radiation on postoperative complications and outcomes.

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