title: Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends.
abstract: BACKGROUND
  Nipple-sparing mastectomy is increasingly used for treatment and prevention of breast cancer. Few data exist on risk factors for complications and reconstruction outcomes.
  
  
  METHODS
  A single-institution retrospective review was performed between 2007 and 2012.
  
  
  RESULTS
  Two hundred eighty-five patients underwent 500 nipple-sparing mastectomy procedures for breast cancer (46 percent) or risk reduction (54 percent). The average body mass index was 24, and 6 percent were smokers. The mean follow-up was 2.17 years. Immediate breast reconstruction (reconstruction rate, 98.8 percent) was performed with direct-to-implant (59 percent), tissue expander/implant (38 percent), or autologous (2 percent) reconstruction. Acellular dermal matrix was used in 71 percent and mesh was used in 11 percent. Seventy-seven reconstructions had radiotherapy. Complications included infection (3.3 percent), skin necrosis (5.2 percent), nipple necrosis (4.4 percent), seroma (1.7 percent), hematoma (1.7 percent), and implant loss (1.9 percent). Positive predictors for total complications included smoking (OR, 3.3; 95 percent CI, 1.289 to 8.486) and periareolar incisions (OR, 3.63; 95 percent CI, 1.850 to 7.107). Increasing body mass index predicted skin necrosis (OR, 1.154; 95 percent CI, 1.036 to 1.286) and preoperative irradiation predicted nipple necrosis (OR, 4.86; 95 percent CI, 1.0197 to 23.169). An inframammary fold incision decreased complications (OR, 0.018; 95 percent CI, 0.0026 to 0.12089). Five-year trends showed increasing numbers of nipple-sparing mastectomy with immediate reconstruction and more single-stage versus two-stage reconstructions (p < 0.05).
  
  
  CONCLUSIONS
  Nipple-sparing mastectomy reconstructions have a low number of complications. Smoking, body mass index, preoperative irradiation, and incision type were predictors of complications.
  
  
  METHODS
  Risk, III.
authors.affiliation: Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Colwell
authors.forename: Oren
authors.initials: O
authors.lastname: Tessler
authors.forename: Alex M
authors.initials: AM
authors.lastname: Lin
authors.forename: Eric
authors.initials: E
authors.lastname: Liao
authors.forename: Jonathan
authors.initials: J
authors.lastname: Winograd
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cetrulo
authors.forename: Rong
authors.initials: R
authors.lastname: Tang
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: William G
authors.initials: WG
authors.lastname: Austen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000639:trends*; D008408:Mastectomy; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome