title: Does the reconstruction method influence development of mastectomy flap complications in nipple-sparing mastectomy?
abstract: OBJECTIVE
  There has been an increase in the use of nipple-sparing mastectomy (NSM) with immediate breast reconstruction for the treatment of early-stage breast cancer patients. Mastectomy flap complication including nipple loss is a major concern and usually associated with the surgical technique. The authors evaluated potential risk factors of mastectomy flap complications, especially focussing on the impact of reconstructive variables.
  
  
  METHODS
  Using a prospectively collected database, we reviewed 130 cases of NSM between January 2009 and December 2012. Only cases using lateral incision were included. Potential patient- and procedure-related risk factors were analysed using logistic regression analysis to investigate associations with the development of mastectomy flap necrosis.
  
  
  RESULTS
  Among the 130 cases, 70 underwent autologous tissue reconstruction and 60 underwent two-stage prosthesis reconstruction using a tissue expander. All patient- and procedure-related characteristics were similar between the two groups. Mastectomy flap complications occurred in 21 cases (16.2%), including total nipple necrosis in 5 (3.8%) and mastectomy flap necrosis in 10 (7.7%). The autologous tissue group showed a significantly lower rate of complications than the prosthesis group (10.0% vs. 23.3%, p = 0.034), and the difference remained significant after adjusting for other factors on multivariate logistic regression analysis (p = 0.024, odds ratio = 3.259). The rate of revision surgery was also significantly lower in the autologous tissue group (1.4% vs. 15.0%, p = 0.004).
  
  
  CONCLUSIONS
  In our study, the reconstruction method was associated with the development of necrotic complications of the mastectomy flap. Careful selection of patients and reconstruction methods may reduce the risk of mastectomy flap complications in NSM.
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea.
authors.forename: Kyeong-Tae
authors.initials: KT
authors.lastname: Lee
authors.forename: Jai-Kyong
authors.initials: JK
authors.lastname: Pyon
authors.forename: Sa-Ik
authors.initials: SI
authors.lastname: Bang
authors.forename: Jeong Eon
authors.initials: JE
authors.lastname: Lee
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D059351:Organ Sparing Treatments; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000473:pathology*; D055815:Young Adult
keywords: Mastectomy flap complications; Nipple-sparing mastectomy; Reconstruction methods