title: Nipple reconstruction after implant-based breast reconstruction: a "matched-pair" outcome analysis focusing on the effects of radiotherapy.
abstract: BACKGROUND
  The major focus of research when addressing nipple reconstruction has been on developing new techniques to provide for long-lasting nipple projection. Rarely, has the outcome of nipple reconstruction as it relates to postoperative morbidity, particularly after implant-based breast reconstruction, been analyzed.
  
  
  METHODS
  A "matched-pair" study was designed to specifically answer the question whether a history of radiotherapy predisposes to a higher complication rate after nipple reconstruction in patients after implant-based breast reconstruction. Only patients with a history of unilateral radiotherapy who underwent bilateral mastectomy and implant-based breast reconstruction followed by bilateral nipple reconstruction were included in the study.
  
  
  RESULTS
  A total of 17 patients (i.e. 34 nipple reconstructions) were identified who met inclusion criteria. The mean age of the study population was 43.5 years (range, 23-69). Complications were seen after a total of 8 nipple reconstructions (23.5 percent). Of these, 7 complications were seen on the irradiated side (41.2 percent) (p = 0.03).
  
  
  CONCLUSIONS
  While nipple reconstruction is a safe procedure after implant-based breast reconstruction in patients without a history of radiotherapy the presence of an irradiated field converts it to a procedure with a significant increase in postoperative complication rate.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, USA. amomeni@stanford.edu
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.forename: Mina
authors.initials: M
authors.lastname: Ghaly
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Gurtner
authors.forename: David M
authors.initials: DM
authors.lastname: Kahn
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Karanas
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast reconstruction; Implant; Nipple reconstruction; Plastic surgery; Radiation