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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
The Inferior Pedicled Dermal Flap: Revisiting a Versatile Technique for Nipple- and Skin-Sparing Mastectomy in Breast
Alper Geyik1, Fatih Berk Ateşşahin1, Hasan Basri Çağli2
1From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University Medicine Faculty Hospital.
Background:
Breast cancer is one of the most common cancers diagnosed worldwide, with an estimated 2.3 million new cases in 2020. The nipple- and skin-sparing mastectomy (NSSM) technique has become a highly preferred surgical treatment option for breast cancer in recent years. This study aimed to elaborate on the inferior pedicled dermal flap technique, present the results of single-stage breast reconstruction following NSSM, and compare postoperative outcomes with those previously reported.
Methods:
Between 2014 and 2023, 420 patients were evaluated retrospectively. Among these patients, 129 patients who underwent 1-stage repair using an inferior pedicled adipodermal flap were included in our study. Patients were analyzed in terms of topographic features, breast size, amount of breast tissue removed, history of chemotherapy and radiation therapy, and magnitude and types of postoperative complications.
Results:
A total of 129 patients with a mean age of 47.07 ± 8.02 years were included in the study. Postoperative complications were observed in 58 breasts (26.9%). These were categorized as major (7.9%) or minor (19.1%). Statistical analysis demonstrated a significant association between increased sternal notch-to-nipple distance and overall complication rates ( P = 0.0027). Similarly, a significant correlation was found between higher breast volume and both total ( P = 0.0035) and major ( P = 0.0092) complication rates.
Conclusions:
A common complication of single-session NSSM and implant reconstruction is areolar skin necrosis; therefore, double-layer repair is recommended to protect the circulation of thin skin flaps after mastectomy. An inferior pedicled adipodermal flap as the second layer under the skin flap can be considered a more reliable technique for ptotic breasts.
