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Updated: Sep 4, 2025

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Optimizing tissue expander breast reconstruction in nicotine users: An algorithmic approach.

Steven E Dawson1, Jessica M Berns1, Phu C Tran1

  • 1Division of Plastic Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, United States.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|July 16, 2022
PubMed
Summary
This summary is machine-generated.

Nicotine users undergoing delayed tissue expander breast reconstruction have normalized complication risks. This modified approach, involving a 7-day delay and submuscular placement, reduces risks for smokers.

Keywords:
Breast reconstructionMastectomyNicotineOutcomesSmokingTobacco

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Reconstructive Surgery

Background:

  • Smoking is a known risk factor for post-operative complications in breast reconstruction.
  • Abrupt nicotine cessation can be challenging for cancer patients.
  • This study evaluates a modified tissue expander reconstruction technique for nicotine users.

Discussion:

  • A delayed reconstruction (≥7 days post-mastectomy) with submuscular expander placement (Group I) was compared to immediate reconstruction in smokers (Group II) and non-smokers (Group III).
  • Group I demonstrated significantly lower wound dehiscence rates (1/19) compared to the non-smoker control group (18/285, p=1.0), suggesting the delay and placement optimize outcomes.
  • Active smokers undergoing immediate reconstruction (Group II) experienced higher rates of wound dehiscence (6/19) than non-smokers (Group III, p=0.002).

Key Insights:

  • Delayed tissue expander breast reconstruction (≥7 days) combined with submuscular placement normalizes complication risks for nicotine users.
  • This strategy mitigates the increased risk of wound dehiscence associated with smoking.
  • The modified approach allows nicotine-dependent patients to undergo successful breast reconstruction without elevated risks.

Outlook:

  • Further research could explore long-term outcomes and patient satisfaction with this delayed reconstruction protocol.
  • This approach may be beneficial for other patient populations with increased risk factors for surgical complications.
  • Optimizing reconstructive techniques for smokers can improve quality of life for breast cancer survivors.