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Updated: Jun 6, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Outcomes and recurrence trends after skin-sparing mastectomy and immediate DIEP flap reconstruction: A single-centre
Mahalakshmi Ishwar1, Nazia Habiba1, Nagy Rizkalla2
1Department of plastic and reconstructive surgery, University Hospitals of Coventry and Warwickshire CV2 2DX, UK.
Introduction:
Mastectomy is indicated in 25-40% patients diagnosed with breast cancer. Skin and Nipple sparing mastectomy (SSM / NSM) are techniques that allow for the option of a single stage reconstructive procedure. DIEP flap remains the gold standard for autologous breast reconstruction with excellent aesthetic outcomes. The aim of this study was to evaluate long term results and recurrence patterns following skin sparing mastectomy and immediate reconstruction (IBR) with DIEP flap.
Methods:
Data were collated retrospectively for all consecutive adult patients undergoing immediate DIEP reconstruction following SSM between 1st July 2010 to 30th June 2023 for all indications at the author's centre. Those who underwent delayed DIEP reconstruction or other methods of IBR were excluded. Primary outcome was the incidence and management of locoregional and distant recurrence(LR) and secondary outcomes included other standard oncological measures and immediate post-operative measures such as skin flap changes following SSM.
Results:
A total of 235 DIEP flaps in 192 patients at a mean(SD) age of 49(40-57) years were analysed. Median(SD) follow up duration was 7.2(1.4-13) years. The isolated local recurrence rate was 2.7%. LR in conjunction with distant metastasis was seen in a further 2.7% and isolated distant metastases were noted in 8.4% patients. LR occurred at a median of 2.76 (0.97-4.55) years from surgery. Isolated LR were treated with surgical resection & flap conservation followed by adjuvant chemoradiation, whereas distant metastases were treated with palliative chemoradiation as appropriate.
Conclusion:
IBR with DIEP following SSM remains oncologically safe with low recurrence rates. LR can be safely managed with excision and conservation of the DIEP flap.
