Impact of Body Composition on Postoperative Outcomes in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction.

Jiae Moon,Jeea Lee,Hye Jung Shin,Dong Won Lee,Hyung Seok Park,Yhenseung Kang,Sumin Lee,Na Young Kim

doi:10.3390/curroncol29010031

Abstract

Nipple-areolar complex (NAC)-related complications are common during nipple-sparing mastectomy (NSM), with obesity as a risk factor. Although the incidence of NAC-related complications after robotic NSM (RNSM) with immediate breast reconstruction (IBR) is lower than that after conventional NSM, it remains one of the most unwanted complications. We aimed to evaluate body composition-based risk factors for NAC-related complications after RNSM with IBR. Data of 92 patients with breast cancer who underwent RNSM with IBR using direct-to-implant or tissue expander from November 2017 to September 2020 were analyzed retrospectively. Risk factors for NAC-related complications were identified with a focus on body composition using preoperative transverse computed tomography at the third lumbar vertebra level. Postoperative complications were assessed for 6 months. The most common complication was NAC ischemia, occurring in 15 patients (16%). Multivariate analysis revealed a low skeletal muscle index/total adipose tissue index (SMI/TATI) ratio as an independent NAC ischemia risk factor. An increase in the SMI/TATI ratio by one decreased the incidence of NAC ischemia by 0.940-fold (p = 0.030). A low SMI/TATI ratio is a risk factor for postoperative NAC ischemia in patients undergoing RNSM with IBR for breast cancer. Preoperative body composition-focused evaluation is more valuable than simple body mass index assessment.

Highlights

Nipple-areolar complex (NAC) ischemia and necrosis are common complications after nipple-sparing mastectomy (NSM) with a prevalence range of 0–48%, mostly 10–15% [1,2,3,4]
The subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and total adipose tissue index (TATI) were significantly higher (p = 0.007,
NAC ischemia occurred in 16% of patients in the current study, and a low SMI/TATI ratio significantly increased the incidence of NAC ischemia after robotic NSM (RNSM) with immediate breast reconstruction (IBR)

Summary

Introduction

Nipple-areolar complex (NAC) ischemia and necrosis are common complications after nipple-sparing mastectomy (NSM) with a prevalence range of 0–48%, mostly 10–15% [1,2,3,4]. Several risk factors for NAC-related complications after a mastectomy with breast reconstruction (BR) have been identified, including obesity, ptosis, large breast weight and volume, prior radiotherapy history, and incision type [1,5,6,7,8], among which, obesity is a well-known risk factor [9,10,11]. Obesity is evaluated using body mass index (BMI), which reflects only body height and weight but does not reflect body composition, such as muscle and adipose tissue compositions. A risk factor analysis of current research, especially obesity, with BMI may be limited as it may not account for exact fat and muscle mass. A risk factor analysis of current research, e3s51-

Objectives

Methods

Results

Discussion

Conclusion