Smoking as a risk factor for wound dehiscence in nipple reconstruction: An analysis of 1683 cases

Zoghbi, Yasmina; Borsting, Emily Ann; Chim, Jimmy H.; Panthaki, Zubin J.

doi:10.1111/tbj.12844

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…The ideal candidate to NAR procedures has aesthetically pleasant breast mounds with adequately vascularized soft tissues [ 3 ]. Certain risk factors can negatively impact wound healing and make NAR more difficult to achieve, including smoking and RT [ 49 , 50 ], that increase risk for necrosis of the neo-nipple [ 6 , 50 , 51 ]. The chosen BR technique is also relevant when planning NAR.…”

Section: Resultsmentioning

confidence: 99%

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

et al. 2020

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Background Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

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Section: Resultsmentioning

confidence: 99%

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

et al. 2020

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“…Smoking reduces scar quality and has a deleterious effect on the vessels by negatively impacting the vascular system . Diabetes mellitus, which can affect wound healing and blood supply to the peripheral parts, was also investigated …”

Section: Discussionmentioning

confidence: 99%

“…18 Diabetes mellitus, which can affect wound healing and blood supply to the peripheral parts, was also investigated. 6,7 Based on such considerations, correlations between various factors were analyzed. The results showed that having two or more of the risk factors resulted in a statistically significant occurrence of necrosis/ischemia (P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…For NAC reconstruction, there are ongoing studies on various surgical techniques using autologous or artificial material for improving outcomes that can satisfy the position, symmetry, size, shape, projection, and color of the NAC. However, various factors such as the location of the scar, smoking status, reconstruction surgery methods, and in particular, a history of radiation therapy, occasionally lead to complications . Particularly, projection loss in the reconstructed nipple due to flap necrosis/ischemia caused by poor blood circulation is a major complication, occurring in up to 75% of cases and may be due to active smoking or an underlying disease such as diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

“…However, various factors such as the location of the scar, smoking status, reconstruction surgery methods, and in particular, a history of radiation therapy, occasionally lead to complications. 6 Particularly, projection loss in the reconstructed nipple due to flap necrosis/ischemia caused by poor blood circulation is a major complication, occurring in up to 75% of cases 3,7 and may be due to active smoking or an underlying disease such as diabetes mellitus. When such problems occur, they often require multiple additional revision operations, and additional complications during these processes may lead to a loss of nipple projection.…”

Section: Introductionmentioning

confidence: 99%

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Safe delayed procedure of nipple reconstruction in poorly circulated nipple

et al. 2019

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Nipple‐areolar complex reconstruction represents the final step in breast reconstruction. However, there is no gold standard nipple reconstruction technique that addresses the issue of blood circulation in the flap, which is the most basic complication. Nipple reconstruction was performed in 21 patients. A delayed procedure was performed when a poor outcome was expected due to marginal pinpoint bleeding in the distal tip after flap elevation during nipple reconstruction. The delayed nipple reconstruction can be viewed as a safe and reliable method for improving nipple blood circulation, reducing complications, and enabling long‐term nipple projection maintenance in high‐risk patients.

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Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions

Doval¹,

Lamelas²,

Daly

et al. 2018

Annals of Plastic Surgery

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Smoking as a risk factor for wound dehiscence in nipple reconstruction: An analysis of 1683 cases

Cited by 3 publications

References 15 publications

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

Safe delayed procedure of nipple reconstruction in poorly circulated nipple

Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Women With Previous Abdominal Incisions

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