Journal time! This is out of March 2014 issue of Plastic and Reconstructive Surgery Journal. The study is out of Boston and is titled, “Breast Reconstruction following Nipple Sparing Mastectomy: Predictors of Complications, Reconstruction Outcomes, and 5 year trends.”
Nipple sparing mastectomy is gaining favor (please see my prior blogs) as a way to do a mastectomy but preserve the nipple areola complex. This has been increasing in part because of
- early stage treatment of breast cancer
- prophylactic mastectomies (angelina jolie and BRCA awareness)
- improved aesthetic outcomes
- better current technique (where we remove the glandular tissue from under the nipple, unlike the subcutaneous mastectomies in the past which left significant tissue under the areola and nipple)
Nipple sparing mastectomy has comparable oncologic risk, with most of the studies showing local recurrence of 3% or less. But how do we make this surgery as safe as possible? What are the risks?
This study was a retrospective, institutional chart review of 500 consecutive nipple sparing and immediate breast reconstructions. The surgical incision varied: inframammary fold, horizontal radial, inferior radial, through an existing scar, or periareolar. Single stage surgery was offered if they were doing a size similar to their preop breast size, assuming they had good skin health observed in surgery. They looked at complications and predicting variables.
- 98.8% had immediate recon
- 3% had to be converted to nipple removal due to positive path margins
- 53% of these surgeries were prophylactic mastectomy
- 86% were bilateral mastectomies
- total complication rate was 12.4%
- flap necrosis 5%
- nipple areola necrosis 4.4%
- infection 3.3%
- seroma 1.7%
- hematoma 1.7%
- implant loss 1.9%
- Risk factors for complications
- periareolar incision (IMF had lowest rate)
- increasing BMI
- smoking
- preop radiation
The volume of nipple sparing mastectomies is increasing. This study shows the rates of issues are low and comprable to other techniques, with a clear nod to radiation, smoking, higher BMI, and the periareolar incision as risk factors.