Embrace the Change

Rodríguez-Feliz, Jose; Codner, Mark A.

doi:10.1097/prs.0000000000001448

Cited by 38 publications

(15 citation statements)

References 21 publications

(27 reference statements)

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“…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]. Patients with an increased BMI and DM are likely to have additional complications due to associated vascular disease [25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m², and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Prepectoral implant placement is also an emerging option for improved breast reconstruction outcomes resulting in fewer operations, faster healing, and reduced need for fat grafting, 20–22 all of which ultimately result in lower overall cost of treatment and higher patient satisfaction. 9 Additional advantages to this technique are improved aesthetic outcomes associated with reduced incidence of animation defect. Consequently, because less aggressive mastectomies and NS techniques have come into favor, performing a prepectoral technique affords potentially less damage to the chest wall while improving cosmesis, which can be ideal for young, active patients with low BMI and thin mastectomy flaps.…”

Section: Discussionmentioning

confidence: 99%

“…1,8 Additionally, because ADMs may reduce tension on the mastectomy flap, they allow for higher initial fill volumes and reduced tissue-expansion time and, in some cases, eliminate the need for a tissue-expansion phase altogether, thus requiring fewer surgeries. 9,10 …”

mentioning

confidence: 99%

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

Schnarrs

Carman

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series.Methods:After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery.Results:The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05).Conclusions:In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.

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“…NSM is associated with excellent aesthetic results and oncologic outcomes that seem equivalent to traditional mastectomy techniques, such as total and skin-sparing mastectomy. 1 , 2 , 6 , 7 , 10 , 20 , 42 However, reconstructive outcomes and risk factors for reconstructive complications in NSM continue to be defined. 9 – 11 , 14 Smoking, obesity, periareolar mastectomy incisions, radiation, and chemotherapy, among other factors, have all been identified as risk factors for adverse outcomes, specifically ischemic complications, after NSM.…”

Section: Discussionmentioning

confidence: 99%

Mastectomy Flap Thickness and Complications in Nipple-Sparing Mastectomy: Objective Evaluation using Magnetic Resonance Imaging

Frey

Salibian

Choi

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Ischemic complications after nipple-sparing mastectomy (NSM) have been associated with numerous variables. However, the impact of NSM flap thickness has been incompletely evaluated.Methods:NSM flap thickness was determined for all NSMs from 2006 to 2016 with available pre- or postoperative breast magnetic resonance imaging (MRIs). Demographics and outcomes were stratified by those with and without ischemic complications.Results:Of 1,037 NSM reconstructions, 420 NSMs had MRI data available, which included 379 preoperative MRIs and 60 postoperative MRIs. Average total preoperative skin/subcutaneous tissue NSM flap thickness was 11.4 mm. Average total postoperative NSM flap thickness was 8.7 mm. NSMs with ischemic complications were found to have significantly thinner overall postoperative NSM flap thickness compared with those without ischemic complications (P = 0.0280). Average overall postoperative NSM flap thickness less than 8.0 mm was found to be an independent predictor of ischemic complications (odds ratio, 6.5263; P = 0.026). In NSMs with both pre- and postoperative MRIs, the overall average postoperative NSM flap thickness was 68.2% of preoperative measurements. Average overall postoperative NSM flap thickness was significantly less than average overall preoperative NSM flap thickness (P < 0.0001). NSMs with ischemic complications were found to have a significantly lower ratio of overall postoperative to preoperative flap thickness (52.0% versus 74.0%; P < 0.0001).Conclusions:Ischemic complications after NSM are significantly associated with thinner postoperative NSM flap thickness. Particularly, NSM flap thickness less than 8.0 mm is a positive independent predictor of ischemic complications. The ratio of postoperative to preoperative NSM flap thickness was significantly lower in reconstructions with ischemic complications.

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Embrace the Change

Abstract: Therapeutic, IV.

Cited by 38 publications

References 21 publications

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

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

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

Mastectomy Flap Thickness and Complications in Nipple-Sparing Mastectomy: Objective Evaluation using Magnetic Resonance Imaging

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