The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction

Rawlani, Vinay; Fiuk, Julia

doi:10.4172/plastic-surgery.1000717

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…Seventy-three studies 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 reported LR rates, complication rates, and/or nipple necrosis rate following NSM. Table 1 presents the number of patients, the number of procedures, the LR rate, the complication rate, and the nipple necrosis rate.…”

Section: Resultsmentioning

confidence: 99%

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

2016

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Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4–156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.

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Section: Resultsmentioning

confidence: 99%

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

2016

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“…Rawlani et al, [33] reported in their study that a higher rate of nipple necrosis was associated with the periareolar incision than using the lateral or inframammary incision in NSM. Regarding the current study, medial breast incisions were avoided instead lateral or lateral inframammary incision were used in NSM.…”

Section: Discussionmentioning

confidence: 94%

Post Nipple-Sparing Mastectomy Reconstruction: Renewed Popularity of Latissimus Dorsi Flap for More Cosmetically Appealing Results

Wahsh

2018

The Egyptian Journal of Plastic and Reconstructive Surgery

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Background: Breast reconstruction became a dynamic continually progressing group of procedures. These procedures are aiming to provide the patients after mastectomy more symmetrical and an aesthetically pleasing recreated breast in the cases which are fulfilling multiple basic oncologic goals. The reconstruction must not impede the oncological safety or cause a delay in detection of local recurrence or adjuvant cancer management. The aim of the current study is to evaluate the surgical outcomes of the immediate breast reconstruction by latissimus dorsi flap in patients after nipple sparing mastectomy regarding the aesthetic results, post-operative complications and patient satisfaction.Patients and Methods: Eight consecutive patients having invasive breast cancer (7 patient have invasive duct carcinoma and a patient has invasive lobular carcinoma) underwent nipple sparing mastectomy. All patients had immediate breast reconstruction by latissimus dorsi flap at Zagazig University hospitals within three years. Surgical outcomes in terms of post-operative complications including hematoma, wound infection, scarring, dorsal seroma, skin necrosis, back pain, and aesthetic outcomes such as breast symmetry, visual difference of bilateral breasts, breast contour, and nipple cosmoses were assessed.Results: Surgical outcomes including post-operative complications; hematoma, wound infection were not detected. Marked back scarring (25%), dorsal seroma (12.5%) were reported. Aesthetic outcomes were satisfactory and 75% of patients reported excellent satisfaction with (2 cases) 25% were not satisfied due to the back scar or volume asymmetry.Conclusion: Following nipple sparing mastectomy, purely autogenous immediate breast reconstruction by latissimus dorsi flap is a valuable reconstructing technique in selected type of patients. It has low incidence of complications, considerable aesthetic outcomes with high patient satisfaction relieving the psychological postmastectomy trauma.

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“…While the individual studies have mixed results relating to NAC complications, the overall sentiment has been that incisions that avoid the NAC tend to result in fewer NAC complications. 8–12 However, one caveat with this impression is that in several studies, the comparison of incision choice is not binomial, and multiple incision types are contained within one cohort, which makes direct comparison of individual incision choice more difficult. All studies to date have evaluated patients with submuscular or partial submuscular reconstructions, which may limit generalizability to patients undergoing prepectoral reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown varied results of incision location on NAC complications, but tend to suggest that incisions placed away from the areola result in decreased rates of ischemic complications. 8–12…”

Section: Introductionmentioning

confidence: 99%

Safety of Incision Placement with Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction

Holland

Wallace

Viner

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: In nipple-sparing mastectomy, adequate perfusion to the nipple-areolar complex (NAC) during reconstruction is paramount to avoiding unwanted outcomes. Previous studies have suggested that periareolar incisions may result in higher rates of NAC complications. However, studies to date have not specifically investigated this in prepectoral reconstruction. The purpose of this study is to evaluate the impact of incision location on NAC complications in patients undergoing prepectoral breast reconstruction. Methods: We performed a retrospective review of all patients who underwent immediate two-stage prepectoral breast reconstruction following nipple-sparing mastectomy between 2015 and 2018 at a single institution. We identified two types of incisions utilized: superior periareolar or inframammary fold (IMF). Patient demographics, comorbidities, and surgical details were compared between incision types, as were NAC complications. Results: A total of 181 consecutive prepectoral breast reconstructions were included for analysis. A superior periareolar incision was used in 113 reconstructions (62%), and an IMF incision was used in 68 reconstructions (38%). There were 33 (18%) total NAC complications in our series. The periareolar incision group had a higher rate of any NAC complication (25% versus 7.4%; P < 0.01), as well as a higher rate of nipple necrosis requiring debridement (9.7% versus 1.5%; P = 0.03). Conclusions: In patients undergoing immediate two-stage prepectoral breast reconstruction following nipple-sparing mastectomy, periareolar incisions are associated with an increased risk of NAC complications compared with IMF incisions. For patients who are candidates for either an IMF or periareolar incision, a periareolar incision should be avoided.

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The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction

Cited by 17 publications

References 22 publications

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures

Post Nipple-Sparing Mastectomy Reconstruction: Renewed Popularity of Latissimus Dorsi Flap for More Cosmetically Appealing Results

Safety of Incision Placement with Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction

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