Stacked Microsurgical Autologous Flap Breast Reconstruction Is an Ideal Option after Unilateral Nipple-Sparing Mastectomy

Abstract

Nipple-sparing mastectomy (NSM) is the latest advancement in the treatment of breast cancer, which permits complete preservation of the nipple-areola complex (NAC). Recent studies suggest similar recurrence rates with NSM compared with traditional mastectomy techniques. [1][2][3][4][5][6] Moreover, NSM has been demonstrated in multiple studies to be a safe and effective procedure from a reconstructive perspective, with acceptably low rates of NAC necrosis among other complications. [7][8][9][10][11][12] As the indications for NSM continue to be established, the popularity of this procedure has risen among both patients and surgeons.NSM allows for the complete range of reconstructive procedures, including both prosthetic and autologous options. 13-15 For many patients, NSM with microsurgical autologous reconstruction is an attractive option as it provides for a natural-appearing breast in a single procedure. Keywords► nipple-sparing mastectomy ► autologous reconstruction ► breast cancer AbstractBackground Nipple-sparing mastectomy (NSM) allows for complete preservation of the nipple-areola complex and is increasing in popularity. Autologous options in NSM provide an aesthetic reconstruction in a single stage; however, donor tissue may be scarce in these patients. Stacked microsurgical breast reconstruction, especially in unilateral cases, is an attractive alternative in NSM that is yet to be described. Methods Patients undergoing NSM with stacked autologous flap reconstruction were identified with demographics, intraoperative variables, and outcomes analyzed. Results Six patients who underwent unilateral NSM with stacked autologous free flaps were identified. The average patient age was 50.17 years and body mass index was 21.67. Average follow-up was 28.62 months. Five (83.3%) patients underwent unilateral NSM and reconstruction for a therapeutic indication. The average mastectomy weight was 235.67 grams. All patients were reconstructed with stacked deep inferior epigastric perforator flaps. The average total flap weight was 397.33 grams. Anastomoses in five stacked flaps (83.3%) were performed in an anterograde/retrograde fashion to the internal mammary (IMA) vessels. In one (16.7%) stacked flap, the two flaps were anastomosed in series to the IMA. There were no major complications and three incidences of minor complications. There were no incidences of partial or complete flap loss. The average number of secondary procedures was 0.83 per patient. Conclusion Stacked microsurgical autologous breast flaps provide an optimal reconstruction after NSM and may be considered the reconstruction of choice in patients undergoing unilateral NSM with inadequate donor site tissue for single-flap reconstruction.