Early Complications after Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Silicone Prosthesis: Results of 214 Procedures

Abstract

Background and Aims: breast reconstruction with silicone prosthesis following nipplesparing mastectomy has become widely accepted as a reconstruction option in women requiring mastectomy for cancer. the purpose of this study was to evaluate the incidence and some factors influencing early local complications in patients undergoing nsm with immediate implant reconstruction.Material and Methods: prospective study was performed on a consecutive series of 214 breast reconstructions in 205 patients. all complications during the six weeks after surgery were recorded. 42 prostheses were implanted after neoadjuvant chemotherapy, 27 patients previously had radiotherapy due to breast conserving surgery and in all other cases surgery was the primary treatment for cancer.Results: the overall six-week complication rate was 16% (35) and included: major skin flap necrosis (4%, 9 procedures), minor skin necrosis (3%, 7), major infection (2%, 5), minor infection (3%, 7), prolonged seroma formation (3%, 6), haematoma (1%, 2) and epidermolysis (1%, 2). in 6% (12) reconstruction procedures explantation of prosthesis was done. neoadjuvant chemotherapy and radiotherapy were not associated with higher rate of complications.Conclusion: nipple-sparing mastectomy with immediate implant reconstruction has acceptable morbidity rate in the hand of experienced oncoplastic surgeon and therefore should be considered as treatment option to women requiring mastectomy.

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

“…Concerns are mostly related to increased early postoperative complications such as infection, wound healing problems, and ischemia or necrosis of the skin or NAC [18,19,20]. Age, skin incision, flap thickness, reconstruction type, smoking, neoadjuvant chemotherapy, preoperative irradiation, and comorbidities have been reported as risk factors for ischemic complications concerning the skin and NAC [1,2,3,4,18,19,21,22,23,24,25,26].…”

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

“…In the majority of contemporary studies, the necrosis rate has been found to be between 0 and 7% (21,22,25,31). In the current study the total necrosis rate was 6%, with 5 (2.5%) patients requiring removal and reconstruction of the NAC due to the extent of necrosis.…”

“…In a 2010 prospective study of 214 consecutive NSMs with immediate silicone implant reconstruction, the overall complication rate was 16% with 6% requiring explantation of the prostheses due to the complication (22). In 2012 the present study began performing NSM with direct-to-implant reconstruction and in the study period identified no difference in complication rates when a permanent implant was placed at the time of mastectomy in lieu of a tissue expander; however, more patients with direct implant-based reconstruction required removal of their implants.…”

“…Overall complication rates for NSM have been reported to be as high as 60% in certain older studies, with more recent data suggesting complication rates of 16-22% (21)(22). In a 2003 study published by Gerber et al (19) the complication rate of NSM was compared with SSM and MRM and the overall complication rates were 20, 20, and 18% respectively.…”

Patient Selection and Technical Considerations in Nipple-Sparing and Areola-Sparing Mastectomy

“…Indeed, the risk for skin necrosis is increased with SSM/NSM and is described in the literature as occurring at a rate of about 16% [42,43]. To prevent possible skin necrosis, additional risk factors should be ruled out before surgery.…”