Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Abstract

Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon' s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast reconstruction; Skin-sparing mastectomy; Nipple-sparing mastectomy; Outcome; Complications; Silicone breast implants; Tissue expanders; Oncoplastic surgery Core tip: In selected patients, nipple-sparing mastectomy (NSM) has allowed an adequate oncologic control with satisfactory aesthetic outcome. In addition, utilizing the native breast skin optimizes the aesthetic outcome of the reconstructed breast and minimizes postmastectomy deformity. The satisfactory results are due to a close collaboration with the oncological surgical ed the technique for benign diseases, however he did not report the procedure for oncological objectives or as a risk-reduction alternative [10,11] . Recently, there has been an increase in clinical experience studies of NSM for breast cancer prophylaxis or early cancer treatment, evidencing revived interest in this surgical procedure [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43...

From radical to nipple sparing mastectomy: Techniques, indications and safety

“…The nipple areola complex may be managed at a second stage if the permanent pathology shows malignancy [27]. Moreover, high false negative rates up to 8.7% have been reported [29]. Finally, intraoperative radiotherapy (ELIOT) to the nipple-areolar complex has been proposed followed by immediate reconstruction with very promising results [30].…”

“…The radial (8.83%) and inframammary fold approach (9.09%) displayed an acceptable nipple necrosis rate [27]. The most common incision performed is the radial incision (47%) followed by the periareolar (27%) and the inframammary fold approach (20%) (Figure 4) [29]. A two-stage approach can also be performed in order to reduce these complications.…”

Qualitative analysis of the viability of autogenous fat grafts grafted in different environments of interstitial pressure. Preliminary results and description of a new experimental model in mini-pigs

“…Autologous fat grafting (AFG) has been widely used in plastic surgery and has allowed reconstruction of different types of tissue defects [1][2][3][4][5][6][7][8][9][10][11][12] . According to the International Society of Aesthetic Plastic Surgery, in 2009, AFG represented almost 6 percent of the nonsurgical aesthetic procedures, with more than 500,000 procedures performed globally 15,16 .…”

“…Despite AFG technique was first introduced by Neuber in 1893 13 , only more recently some authors have described technique details, expanding its availability and making it as a constant topic in many centers worldwide [1][2][3][4][5][6][7][8][9][10][11][12] . However, AFG is not a standard technique and clinical series demonstrate a variability of surgical procedures and results 5,11,14,15 .…”

“…The possibility to transfer significant volume of fat has greatly improved the restoration of tissue defects following oncological diseased, congenital birth defects or major traumas [7][8][9][10] .…”