Abstract
Background Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits. Due to the lack of guidelines, the types of incisions in NSM vary and which method is superior remains a debate. In this study, we hypothesized that the periareolar incision has a higher risk of complications, such as nipple-areolar complex (NAC) necrosis, than other incisions. Methods A retrospective chart review was conducted and divided into three groups: the periareolar, radial, and lateral incision groups. The reconstruction method and complications of NAC necrosis, wound dehiscence, seroma, hematoma, infection, and reconstruction failure were investigated. Results A total of 103 patients (periareolar incision (33%, n = 34), radial incision (39.8%, n = 41), and lateral incision (27.2%, n = 28)) who underwent NSM and immediate breast reconstruction from 2018 to 2020 were included. The reconstruction methods were direct-to-implant, DIEP flap, LD flap, and PAP flap, and there was all of which had no statistically significant difference between the groups regarding the reconstruction method (p=0.257). In terms of complications, there was no significant difference in NAC necrosis (29.4%, 19.5%, and 21.4%, in the periareolar, radial, and lateral groups, respectively; p=0.578), wound dehiscence, seroma or hematoma, infection, and reconstruction failure. Conclusion Breast reconstruction following NSM through periareolar incision does not increase the incidence of complications, including NAC necrosis. However, since only Asian patients with low BMI were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained.
Highlights
Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits
Since only Asian patients with low body mass index (BMI) were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained
E data were collected after obtaining approval from the institutional review board, and a retrospective chart review was conducted. e patients’ demographic information, age, body mass index (BMI), comorbidities, smoking habits, neoadjuvant chemotherapy, postoperative chemotherapy, neoadjuvant radiotherapy (RT), postoperative RT, hormonal therapy, trastuzumab administration data, and grades of breast ptosis according to Regnault ptosis classification, was collected. e reconstruction weights (g) were recorded according to the type of NSM incision, reconstruction modality (direct-to-implant (DTI), deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap, or profunda artery perforator (PAP) flap), and mastectomy specimen weight (g). e postoperative complications were the primary outcome and included major necrosis of the nipple-areolar complex (NAC), minor necrosis, necrosis of the mastectomy skin, wound dehiscence, seroma, hematoma, and infections
Summary
Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits. E reconstruction method and complications of NAC necrosis, wound dehiscence, seroma, hematoma, infection, and reconstruction failure were investigated. A total of 103 patients (periareolar incision (33%, n 34), radial incision (39.8%, n 41), and lateral incision (27.2%, n 28)) who underwent NSM and immediate breast reconstruction from 2018 to 2020 were included. There was no significant difference in NAC necrosis (29.4%, 19.5%, and 21.4%, in the periareolar, radial, and lateral groups, respectively; p 0.578), wound dehiscence, seroma or hematoma, infection, and reconstruction failure. Breast reconstruction following NSM through periareolar incision does not increase the incidence of complications, including NAC necrosis. Since only Asian patients with low BMI were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained
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