title: Time to completion of nipple reconstruction: what factors are involved?
abstract: BACKGROUND
  Nipple reconstruction is often used as a marker for completion of the breast reconstructive process. The purpose of this study was to determine the average time to nipple reconstruction and the factors that influence this process.
  
  
  METHODS
  All patients who underwent postmastectomy breast reconstruction at Emory University between 2005 and 2011 were reviewed. Only those who had completed nipple reconstruction were included. Variables recorded were body mass index, age, smoking history, surgeon, presence of preoperative or postoperative chemotherapy or radiation therapy, type of reconstruction, timing of reconstruction, unilateral or bilateral reconstruction, and complication history. Time to completion of nipple reconstruction was calculated and comparisons were made.
  
  
  RESULTS
  A total of 451 patients completed nipple reconstruction (128 implant reconstructions, 120 latissimus plus implant reconstructions, 23 latissimus only reconstructions, and 180 transverse rectus abdominus myocutaneous flap [TRAM] or deep inferior epigastric perforator flap [DIEP] reconstructions). Average time to nipple reconstruction was 12.25 months. Patients who underwent TRAM or DIEP flaps completed reconstruction on average earlier than implant-based reconstruction and latissimus-only reconstruction (8.67 vs 11.2 and 11.3 months, respectively, P = 0.0016). Patients who underwent postoperative chemotherapy or radiation therapy were delayed compared to those that did not (11.3 vs 9.33 and 13.87 vs 9.87 months, P = 0.0315 and P = 0.0052). Timing of completion was also dependent on attending surgeon (9.8 and 11.43 months for the 2 senior surgeons, P = 0.0135) and presence of complications (10.3 compared to 9.77 months for patients without complications, P = 0.0334). Body mass index, smoking history, preoperative chemotherapy or radiation therapy, timing of reconstruction, and unilateral versus bilateral reconstruction did not affect time to nipple reconstruction.
  
  
  CONCLUSIONS
  Type of reconstruction, surgeon, presence of complications, and need for postoperative chemotherapy or radiation therapy all affect timing to completion of breast reconstruction. Patients should be counseled as to these factors at the initial consultation to set appropriate expectations.
authors.affiliation: Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA 30308, USA. alosken@emory.edu
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
authors.forename: Claire S
authors.initials: CS
authors.lastname: Duggal
authors.forename: Karan A
authors.initials: KA
authors.lastname: Desai
authors.forename: Meghan C
authors.initials: MC
authors.lastname: McCullough
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gruszynski
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D008408:Mastectomy; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome