One-stage nipple and breast reconstruction using a deep inferior epigastric perforator flap after a skin-sparing mastectomy

Abstract

Background Nipple reconstruction is usually performed as a delayed procedure in patients with breast cancer who undergo skin-sparing mastectomy and breast reconstruction surgery using a deep inferior epigastric perforator (DIEP) flap. The authors designed this study to evaluate the utility of breast reconstruction based on a DIEP flap and immediate nipple reconstruction. Methods A retrospective review was conducted of all patients who underwent breast reconstruction performed by a single plastic surgeon from October 2016 to June 2018. Through a questionnaire and chart review, we compared surgical results and complications in cases of single-stage nipple reconstruction after skin-sparing mastectomy (n = 17) with patients who underwent delayed nipple reconstruction after skin-sparing mastectomy, modified radical mastectomy, or simple mastectomy (n = 7). Results In a subjective analysis using clinical photos, the immediate nipple reconstruction group had higher scores than their counterparts in an evaluation of the nipple-areolar complex (NAC) (NAC placement, 3.34 vs. 3.04; nipple projection, 3.05 vs. 3.03; nipple size, 3.30 vs. 3.29). No significant differences between the groups were found in terms of complications. Conclusions Simultaneous nipple reconstruction is a reliable surgical method with economic advantages. No differences were found in terms of outcomes and complications in comparison to delayed reconstruction. Therefore, surgeons can consider simultaneous nipple reconstruction without particular concerns about asymmetry or necrosis.

Immediate Reconstruction of the Nipple-areola Complex Using Inferior Pedicle Skin for Central Tumors of the Breast

“…Immediate reconstruction of the nipple in patients having mastectomy and reconstruction has also been previously reported. 11 , 12 There are also other TM techniques described to improve the cosmetic outcome following excision of central tumors without the reconstruction of the NAC. 3 , 13 Johnson et al 3 describe a technical modification of the Grisotti flap in patients with short nipple to inferior mammary crease distance.…”

Unilateral immediate deep inferior epigastric artery perforator flap breast reconstruction following skin sparing mastectomy: A comparative study on revision surgeries to improve breast symmetry

“…To date, few studies have reported series of single-stage autologous breast reconstructions (Cho et al, 2020;Haykal & Guay, 2009;Laporta et al, 2016;Levine et al, 2013;Losken et al, 2002;Wade et al, 2016) after SSM or nipple sparing mastectomy (NSM). Losken 2016) reported a one-stage DIEP flap reconstruction presenting a contralateral symmetrization algorithm that led to aesthetic outcomes and patient satisfaction comparable to staged procedures.…”

“…To date, few studies have reported series of single‐stage autologous breast reconstructions (Cho et al, 2020; Haykal & Guay, 2009; Laporta et al, 2016; Levine et al, 2013; Losken et al, 2002; Wade et al, 2016) after SSM or nipple sparing mastectomy (NSM). Losken et al (2002) presented a series of 1394 patients, without comparing outcomes between simultaneous and staged procedures.…”

“…The DIEP flap can be considered the gold standard for autologous breast reconstruction (Egeberg et al, 2012; Kroll, Sharma, et al, 2001; Macadam et al, 2016; Man et al, 2009; Rozen & Ashton, 2009; Schaverien & Butler, 2017; Wade et al, 2017; Wu et al, 2008), despite this the number of revision surgeries following this procedure is still high (Enajat et al, 2010). Efforts focused on single‐stage breast reconstruction (Cho et al, 2020; Davila et al, 2013; Haykal & Guay, 2009; Levine et al, 2013; Susarla et al, 2015) have prompted the authors to evaluate their own breast reconstruction service and outcomes to provide data on single stage procedures with DIEP flap breast reconstruction with a focus on the number of revision surgeries (Wade et al, 2016).…”

“…Furthermore, after SSM the position of the DIEP flap skin is expected to be unchanged during nipple reconstruction. As suggested by some authors (Cho et al, 2020), a true one‐stage DIEP flap reconstruction after SSM needs the patient to be aware that after discharge there is a very small chance she will undergo surgery again. Following implementation of this standardized DIEP flap inset technique, we are now focusing on offering immediate nipple reconstruction, when possible and safe, after SSM.…”