Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients

Abstract

Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025).Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.

Safety of Augmenting Breast Volume in Direct-to-Implant Breast Reconstruction With Contralateral Breast Augmentation

“…Among the mastectomy types, NSM was found to increase the risk of any complication; however, this was not a novel finding because it has been reported earlier in numerous studies 21,22 . A recent trend in mastectomy is to perform NSM as much as possible.…”

“…Among the mastectomy types, NSM was found to increase the risk of any complication; however, this was not a novel finding because it has been reported earlier in numerous studies. 21,22 A recent trend in mastectomy is to perform NSM as much as possible. To prevent complications, it is necessary to check the thickness of the mastectomy skin flap or use intraoperative indocyanine green (ICG) angiography during reconstruction.…”

Radiotherapy dosimetry and radiotherapy related complications of immediate implant-based reconstruction after breast cancer surgery

“…Radiation therapy resulted in a higher, but not statistically significant risk of late complications compared to non-irradiated patients ( 28 ). It had also been suggested that age over 50 years and a larger mastectomy weight were associated with a higher risk of acute complications, but not with PMRT ( 29 ). It was evident that the relationship between radiotherapy and high implant-related complications is not absolute.…”