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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction

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Immediate Versus Delayed-Immediate Autologous Breast Reconstruction After Nipple-Sparing Mastectomy.

Laura L Barnes¹, Anne Patterson¹, Melinda Lem

¹From the Division of Plastic and Reconstructive Surgery, University of California, San Francisco.

Annals of Plastic Surgery

|May 5, 2023

Summary

Immediate autologous breast reconstruction after nipple-sparing mastectomy (NSM) shows higher rates of flap necrosis but fewer infections compared to delayed-immediate reconstruction. Delayed reconstruction leads to more infections and readmissions, despite lower flap necrosis rates.

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Area of Science:

Plastic Surgery
Oncology
Breast Reconstruction

Background:

Nipple-sparing mastectomy (NSM) is a breast cancer surgery requiring reconstruction.
Autologous reconstruction can be performed immediately or delayed after NSM.
Optimal timing for autologous reconstruction post-NSM remains unclear.

Purpose of the Study:

To compare patient outcomes and complication rates between immediate and delayed-immediate autologous breast reconstruction following NSM.

Main Methods:

Retrospective chart review of patients undergoing autologous abdomen-based free flap reconstruction after NSM (2004-2021).
Stratification into immediate and delayed-immediate reconstruction groups.
Analysis of all surgical complications.

Main Results:

Immediate reconstruction (59 patients) had higher rates of delayed wound healing, reoperation, mastectomy skin flap necrosis, and nipple-areolar complex necrosis compared to delayed-immediate (42 patients).
Cumulative analysis showed higher mastectomy skin flap necrosis in the immediate group.
The delayed-immediate group had significantly higher rates of readmission, infection, and antibiotic use.

Conclusions:

Immediate autologous reconstruction after NSM offers benefits over tissue expanders and delayed methods.
While immediate reconstruction increases mastectomy skin flap necrosis, it is often manageable.
Delayed-immediate reconstruction is associated with higher infectious complication rates.