Implant Reconstruction in Nipple Sparing Mastectomy

Abstract

Nipple sparing mastectomy has been popularized in the modern era of breast cancer treatment due to its touted advantages with regard to resultant body image and reconstructive outcome. Implant-based techniques remain the most prevalent means of breast reconstruction. Special considerations regarding patient selection and technique are reviewed for implant reconstruction in the setting of mastectomy with nipple preservation. Applications for prepectoral and direct-to-implant reconstruction are discussed and published outcomes are summarized.

Prepectoral Direct-to-Implant Breast Reconstruction without Placement of Acellular Dermal Matrix or Mesh after Nipple-Sparing Mastectomy

“…Capsular contracture is a common adverse outcome following implant breast reconstruction, often associated with radiation treatment. Chu et al 6 in a literature review also showed that preoperative and postoperative radiation were associated with a higher rate of implant loss, with statistical significance. Muscle fibrosis can be a contributor to breast reconstruction contracture after radiation.…”

“…1,5 However, patients must be selected properly to avoid poor cosmetic outcomes and additional complications. 6 Implant placements can be prepectoral or subpectoral. Because it is easier to execute, creating less pain and discomfort in the postoperative period, and has an absence of animation deformity attributable to pectoralis major muscle spasm, the prepectoral implant has become an acceptable option for women after mastectomy.…”

“…Because of a higher risk of nipple-areola complex necrosis with periareolar incision, radial and inframammary fold incisions are increasingly selected by most surgeons, with satisfactory cosmetic and oncologic outcomes. [1][2][3][4][5][6][7]…”

“…Because it is easier to execute, creating less pain and discomfort in the postoperative period, and has an absence of animation deformity attributable to pectoralis major muscle spasm, the prepectoral implant has become an acceptable option for women after mastectomy. 1,[6][7][8][9][10] This technique, being a recent advancement, continues to evolve, but there are some remaining controversial issues regarding indications, limits, specific complications, and long-term results.…”

Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: A multi-institutional validation study

“…However, PMRT with regional node irradiation can be associated with increased toxicity such as the occurrence of fat necrosis in patients with autologous reconstruction and high mean internal mammary node dose [6]. Although PMRT often leads to poor cosmesis and satisfaction outcomes in women who undergo breast reconstruction [7], these issues have gradually been resolved with recent advances in reconstructive and radiotherapy (RT) techniques [8,9]. Therefore, a collaborative effort among surgeons and radiation oncologists is important to mitigate complications without increasing recurrence in the treatment of patients planning to undergo both breast reconstruction and PMRT.…”