Nipple-sparing mastectomy with immediate breast reconstruction – early complications and outcomes of the treatment

Bocian, Artur; Kędzierawski, Piotr; Kurczych, Krzysztof; Jasnowski, Przemysław; Maliszewski, Daniel; Kołacińska, Agnieszka

doi:10.5114/pm.2020.99618

Cited by 1 publication

(6 citation statements)

References 30 publications

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“…Nipple-sparing mastectomy has been proven to be oncologically safe in appropriately selected patients for the treatment of invasive breast cancer and breast cancer prophylaxis while also producing superior aesthetic results compared with simple and skin-sparing mastectomies. [2][3][4][6][7][8][15][16][17] Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement. [2][3][4][5][6]9,16 However, ischemia-related complications due to increased perfusion requirements of the breast skin and NAC remains a significant issue, with the prevalence of ischemic complications ranging from 2% to 30% in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][6][7][8][15][16][17] Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement. [2][3][4][5][6]9,16 However, ischemia-related complications due to increased perfusion requirements of the breast skin and NAC remains a significant issue, with the prevalence of ischemic complications ranging from 2% to 30% in the literature. [6][7][8] With the resurgence of prepectoral positioning of implants, early identification of ischemia is even more paramount.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] However, because of increased perfusion requirements of the additional skin envelope and NAC, ischemia or necrosis of the mastectomy skin flap and/or NAC itself is a frequent complication reported in up to 30% of patients. [6][7][8][9] Hyperbaric oxygen therapy (HBOT) is well established in the treatment of chronic wounds, osteoradionecrosis, decompression sickness, carbon monoxide poisoning, and several other indications. However, HBOT has also recently emerged as a potential adjunct to improve blood flow and oxygenation to threatened mastectomy flaps.…”

mentioning

confidence: 99%

“…In many high-volume breast centers in the United States, NSM has in fact become the preferred approach in appropriate candidates, namely, those with peripherally located tumors <3 cm in size with a tumor-to-nipple distance >2 cm, negative retro-areolar margins, clinically negative axillary examination, and no skin or chest wall involvement 2–5 . However, because of increased perfusion requirements of the additional skin envelope and NAC, ischemia or necrosis of the mastectomy skin flap and/or NAC itself is a frequent complication reported in up to 30% of patients 6–9 …”

mentioning

confidence: 99%

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Hyperbaric Oxygen Therapy for Threatened Nipple-Sparing Mastectomy Flaps

Nasr¹,

Rifkin²,

Muller³

et al. 2023

Ann Plast Surg

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Background: Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes. However, ischemia or necrosis of the skin flap and/or nipple-areola complex remain frequent complications. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunct for flap salvage, although it is not currently a widely accepted practice. Here we review our institution's experience using a protocol of HBOT in patients with signs of flap ischemia or necrosis after NSM. Methods: Retrospective review identified all patients treated with HBOT at our institution's hyperbaric and wound care center because of signs of ischemia after NSM. Treatment parameters consisted of 90-minute dives at 2.0 atmosphere once or twice daily. Patients unable to tolerate dives were considered a treatment failure, whereas those lost to follow-up were excluded from analysis. Patient demographics, surgical characteristics, and treatment indications were recorded. Primary outcomes assessed were flap salvage (no operative revision), need for revision procedures, and treatment complications. Results: A total of 17 patients and 25 breasts met the inclusion criteria. The mean ± SD time to initiation of HBOT was 9.47 ± 12.7 days. The mean ± SD age was 46.7 ± 10.4 years, and mean ± SD follow-up time was 36.5 ± 25.6 days. Indications for NSM included invasive cancer (41.2%), carcinoma in situ (29.4%), and breast cancer prophylaxis (29.4%). Initial reconstruction included tissue-expander placement (47.1%), autologous reconstruction with deep inferior epigastric flaps (29.4%), and direct-to-implant reconstruction (23.5%). Hyperbaric oxygen therapy indications included ischemia or venous congestion for 15 breasts (60.0%) and partial thickness necrosis for 10 breasts (40.0%). Flap salvage was achieved in 22 of 25 breasts (88.0%). Reoperation was required for 3 breasts (12.0%). Hyperbaric oxygen therapy-related complications were observed in 4 patients (23.5%), which included 3 patients with mild ear pain and 1 patient with severe sinus pressure leading to treatment abortion. Conclusions: Nipple-sparing mastectomy is an invaluable tool for breast and plastic surgeons to achieve oncologic and cosmetic goals. However, ischemia or necrosis of the nipple-areola complex or mastectomy skin flap remains frequent complications. Hyperbaric oxygen therapy has emerged as a possible intervention for threatened flaps. Our results demonstrate the utility of HBOT in this population to achieve excellent NSM flap salvage rates.

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