Protecting Nipple Perfusion by Devascularization and Surgical Delay in Patients at Risk for Ischemic Complications During Nipple-Sparing Mastectomies

Bertoni, Danielle; Nguyen, Dung; Rochlin, Danielle H; Hernandez‐Boussard, Tina; Meyer, Shannon; Choy, Nicole; Gurtner, Geoffrey C.; Wapnir, Irene

doi:10.1245/s10434-016-5201-8

Cited by 34 publications

(39 citation statements)

References 21 publications

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“…Smoking is established to increase complication rates in breast surgery (5,(31)(32)(33)(34)(35)(36). In a prospective study published by Matsen et al (33) examining skin flap necrosis rates following any mastectomy with reconstruction, 14% of patients had some level of skin flap necrosis (33).…”

Section: Discussionmentioning

confidence: 99%

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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Abstract. Nipple-sparing mastectomies (NSMs) are increasingly used in the surgical treatment of patients with breast cancer and for prevention of breast cancer. The present study was performed to review the outcomes of patients undergoing NSMs at a single large university setting. A retrospective chart review was performed on all patients undergoing NSMs from 2008-2014. Charts were reviewed for demographic data and patient characteristics. Tumor and breast size, cancer recurrence and complications were also evaluated. Descriptive statistics were utilized to summarize the findings. From 2008From -2014 NSMs. The mean patient age was 44.4 years (range, 20-77). The average body mass index was 24 (range, 18-47). Breast weight was available for 106 specimens, with a mean weight of 475.5 g (range, 124.1-1,625.0 g). Seventy-three NSMs were performed for cancer and 124 were performed prophylactically. The mean tumor width was 1.38 cm (range, 0-6.0 cm), with an average nipple to tumor distance of 5.87 cm (range, 2.93-10.0 cm). Three (4%) patients required removal of the nipple areolar complex (NAC) due to pathological extension of the tumor. A total of 34 (17.2%) complications occurred, including infections, hematomas and nipple necrosis, with 9 requiring removal of the NAC and 13 requiring removal of the tissue expander or implant. Smokers had a 36.0% (9/25) complication rate, compared with 14.5% (25/172) of nonsmokers (P<0.05). During follow-up, one recurrence was noted, located on the chest wall. There were no recurrences in the NAC group. Therefore, NSMs may safely be performed without compromising oncologic outcomes or increasing complication rates in properly selected patients.

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Section: Discussionmentioning

confidence: 99%

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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“…2 To help combat this problem, especially in high-risk patients, surgeons are performing a delay procedure before the final mastectomy to help improve nipple vascularity and decrease necrosis rates. In 2005, Palmieri et al 3 were the first to describe a nipple delay technique with the use of laparoscopic scissors placed through a small stab incision to sever the blood supply traveling from the gland to the NAC.…”

Section: Discussionmentioning

confidence: 99%

“…They performed a nipple delay on high-risk patients with an active smoking history, preexisting surgical scars, or a sternal notch to a nipple distance of 28 cm or greater. 4 Since 2011, only a few studies have been published documenting the efficacy of nipple delay with each group having slight variations on the technique described by Jensen et al 2,4,5 …”

Section: Discussionmentioning

confidence: 99%

“…1 Partial or complete nipple necrosis is a well-known complication of this procedure with rates in the literature ranging between 1% and 9%. 2 In high-risk patients, surgeons are performing a delay procedure before the mastectomy to help improve nipple vascularity and decrease necrosis rates. 3 We present a technique of using a short-lasting bioresorbable hyaluronate–carboxymethylcellulose membrane (Seprafilm; Genzyme, Cambridge, Mass.)…”

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confidence: 99%

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The Use of a Hyaluronic Acid–Carboxymethylcellulose Membrane as an Adhesion Barrier during Nipple Delay before Nipple-preserving Mastectomy

Lamelas

Jablonka

Harmaty

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Summary:The desire for nipple-preserving mastectomies has increased over the past decade as studies have proven that the procedure has comparable oncologic risk as a traditional mastectomy in both therapeutic and prophylactic cases. Partial or complete nipple necrosis is a well-known complication of this procedure with rates in the literature ranging between 1% and 9%. In high-risk patients, surgeons are performing a delay procedure before the mastectomy to help improve nipple vascularity and decrease necrosis rates. We present a technique of using a short-lasting bioresorbable hyaluronate–carboxymethylcellulose membrane (Seprafilm; Genzyme, Cambridge, Mass.) during the delay procedure as an interpositional sheet, which prevents adhesion of the anterior breast skin from the underlying gland to both block revascularization to improve nipple perfusion and prevent the need for redissection of the previously created plane during the final mastectomy.

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“…Staged devascularization of the NAC can also be performed 1-3 weeks prior to NSM [50,51]. This is performed by using a pre-existing incision or making a vertical or radial lateral incision then undermining the NAC and the adjacent skin for 4-5 cm in the mastectomy plane.…”

Section: Ptosis Managementmentioning

confidence: 99%

Immediate Breast Reconstruction with Free Autologous Tissue Transfer

Zelones¹,

Inchauste²,

Nguyen³

2020

Breast Cancer and Breast Reconstruction

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Immediate breast reconstruction in the United States is increasing with the majority of patients undergoing implant-based reconstruction. The use of pedicled autologous tissues has also been used, but due to significant donor site morbidity, free autologous tissue transfer has largely replaced it. The gold standard currently for breast reconstruction is free autologous tissue transfer from the abdomen if no contraindications exist. However, not all hospitals have the expertise available to perform free autologous tissue transfers for breast reconstruction. Other donor sites available for free autologous tissue transfer include the thigh and gluteal areas. With advances in free tissue transfer techniques, the donor site morbidity and flap failure rates are minimal. The ultimate goal for any breast reconstruction patient is to achieve the appropriate size, shape, symmetry, softness, and sensation. The goal of this chapter is to assist in achieving these goals in the immediate breast reconstruction patient through the use of free autologous tissue transfers.

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Protecting Nipple Perfusion by Devascularization and Surgical Delay in Patients at Risk for Ischemic Complications During Nipple-Sparing Mastectomies

Abstract: Adaptive circulatory changes after devascularization allow tissues to tolerate the additional ischemic challenge of mastectomy. Our findings support extending 2-staged operations to high-risk women previously considered unsuitable for NSM.

Cited by 34 publications

References 21 publications

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

The Use of a Hyaluronic Acid–Carboxymethylcellulose Membrane as an Adhesion Barrier during Nipple Delay before Nipple-preserving Mastectomy

Immediate Breast Reconstruction with Free Autologous Tissue Transfer

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