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Direct-to-Implant versus Immediate Free Flap Reconstruction after Nipple-Sparing Mastectomy: A Propensity
Salma A Abdou1, Banafsheh Sharif-Askary1, Idanis Perez-Alvarez2
1From the Departments of Plastic Surgery.
Plastic and Reconstructive Surgery
|February 2, 2023
Summary
Direct-to-implant (DTI) and immediate free flap (FF) breast reconstruction after nipple-sparing mastectomy (NSM) show similar low rates of ischemic complications. Both DTI and FF are safe options for single-stage breast reconstruction following NSM.
Area of Science:
- Plastic Surgery
- Oncology
- Breast Reconstruction
Background:
- Nipple-sparing mastectomy (NSM) is increasingly performed for breast cancer.
- Direct-to-implant (DTI) and immediate free flap (FF) are reconstruction options post-NSM.
- Comparative studies on ischemic complications are limited, with few controlling for influencing factors.
Purpose of the Study:
- To compare ischemic complication rates between DTI and immediate FF breast reconstruction after NSM.
- To control for factors influencing complications in a matched cohort.
Main Methods:
- Retrospective review of NSMs between 2014-2020.
- Propensity score matching used to compare DTI and immediate FF groups.
- Key outcome: 30-day ischemic complications.
Main Results:
- 54 breasts in each group (DTI vs. FF).
- No significant difference in partial nipple-areola complex necrosis (5.6% vs. 3.7%).
- No significant difference in mastectomy flap necrosis (5.6% vs. 11.1%) or total NAC necrosis (1.9% for both).
Conclusions:
- Both DTI and immediate FF reconstruction are safe and viable options after NSM.
- These techniques offer the benefit of a single-stage reconstructive procedure.
- Patients can be offered either DTI or FF reconstruction with comparable safety profiles regarding ischemic complications.
