Breast Reconstruction and Nipple-Sparing Mastectomy: Technical Modifications and Their Outcomes Over Time at an...

Area of Science:

• Oncology
• Plastic Surgery
• Surgical Innovation

Background:

• Nipple-sparing mastectomy (NSM) aims for superior aesthetic outcomes by preserving breast envelope and nipple-areolar complex.
• NSM presents challenges including mastectomy flap ischemia and ensuring complete oncologic resection.
• Technique modifications and reconstructive outcomes of NSM are continuously evaluated.

Purpose of the Study:

• To review institutional experience with nipple-sparing mastectomy (NSM) and its modifications.
• To evaluate reconstructive outcomes following NSM.
• To identify factors influencing complication rates and successful reconstruction.

Main Methods:

• Retrospective review of consecutive patients undergoing NSM and breast reconstruction over an 8-year period.
• Analysis of NSM incision techniques, complication rates, and reconstructive procedures.
• Inclusion of intraoperative fluorescent angiography (FA) data for assessing mastectomy skin perfusion.

Main Results:

• 95 NSMs were performed on 55 patients for various breast conditions, including cancer and risk reduction.
• Overall complication rate was 50.9%, with nipple necrosis at 8.4%. Rates decreased in the latter 4 years of the study.
• Intraoperative FA identified poor perfusion in over 70% of indicated cases, leading to delayed reconstruction in 83.3% of those patients.

Conclusions:

• Nipple-sparing mastectomy (NSM) use and technique diversity are increasing at our institution, with decreasing complication rates.
• Immediate, implant-based reconstruction is the most common approach following NSM.
• Fluorescent angiography aids in managing mastectomy complications, and most patients achieve successful breast reconstruction completion.