Abstract P2-18-07: Nipple sparing mastectomy-infectious complication risk. A preliminary assessment of the American Society of Breast Surgeons nipple sparing mastectomy registry

Abstract

Abstract Objectives: The American Society of Breast Surgeons (ASBS) Nipple Sparing Mastectomy Registry (NSMR) is a prospective, IRB approved, non-randomized, multi-institutional registry assessing surgical techniques, utilized metrics, oncologic outcome, and aesthetic outcome of nipple sparing mastectomies. The registry has been open for enrollment for 26 months. The target accrual is 1000 individuals. This abstract specifically analyzes rates of post-operative infection in NSMs. Methods: Fifty two investigators from 41 institutions are participating in the ASBS NSMR. A total of 373 patients underwent 631 mastectomies, with indications of prophylaxis (365), cancer (248), and unknown (18). We assessed a sub group of 449 mastectomies, with indications of prophylaxis (253) and cancer (196) that had all data sets completed. We assessed infection rates(characterized as needing oral or iv antibiotics with or without removal of implant/expander and/or debridement) in the entire group as well as by indication (cancer vs. prophylaxis). Factors such as smoking history, previous radiation therapy, previous surgery, incision type, reconstruction technique, and flap dissection technique were analyzed. Results: In a subgroup of 449 mastectomies (253 prophylactic and 196 cancer): Post operative infections were reported in 22 (4.9%) of patients: 7 (3.6%) of mastectomies with an indication of cancer and 15 (5.9%) of prophylactic mastectomies (p-value 0.3140). Infections were characterized as: treatment with oral antibiotics alone, treatment with i.v. antibiotics alone, iv antibiotics with washout or debridement, or antibiotics and implant/ tissue expander removal. No correlation was found in smoking history (p-value 1.000), previous breast surgery (p-value 0.1277) or previous radiation (p-value 0.6024). No correlation was found in incision utilized, reconstruction technique, or method of flap dissection either. Conclusion: The rate of postoperative infections in nipple sparing mastectomies is comparable if not lower than non-nipple sparing mastectomies. No statistically significant difference in infection rate was found between mastectomies completed for prophylaxis or cancer. No correlation was found between factors such as smoking history, history of radiation therapy, prior breast surgery, incision utilized, reconstruction technique, or method of flap dissection. Improved aesthetics with a nipple sparing approach (technically more demanding and typically through a smaller incision) does not come at the cost of a higher rate of infectious complications. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-07.