title: Reconstructive approach for patients with augmentation mammaplasty undergoing nipple-sparing mastectomy.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) is a recent advance in the therapeutic and prophylactic management of breast cancer; however, the procedure is associated with increased reconstructive complications. Data on NSM after previous breast augmentation are limited.
  
  
  OBJECTIVE
  The authors compared reconstructive complications after NSM between patients with previously augmented breasts and a larger cohort that had not undergone prior augmentation. An approach to NSM that involves 2-stage reconstruction in augmented patients is also described.
  
  
  METHODS
  Medical records of NSMs performed at New York University Langone Medical Center from 2006 to 2013 were reviewed. Data points evaluated included patient characteristics, comorbidities, breast implant plane, and reconstructive complications. Fisher's exact and t tests were used for the comparisons.
  
  
  RESULTS
  During the study period, NSMs were performed in 17 augmented breasts at this institution. After NSM, 15 of these breasts underwent implant-based reconstruction and 2 breasts underwent microvascular free flaps. Reconstructive complications included 1 hematoma managed nonoperatively (5.9%) and 1 partial necrosis of the nipple-areola complex (NAC) (5.9%). Compared with the larger nonaugmented cohort (n=332), patients with previously augmented breasts had fewer complications, and there were no statistically significant differences in the rates of mastectomy flap necrosis, partial NAC necrosis, complete NAC necrosis, hematoma, capsular contracture, explantation, implant displacement, seroma, or breast cellulitis.
  
  
  CONCLUSIONS
  The results indicate that NSM reconstruction is associated with minimal complications in patients with previous augmentation mammaplasty.
  
  
  METHODS
  4.
authors.affiliation: Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York michael.alperovich@nyumc.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Alperovich
authors.affiliation: Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York.
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.affiliation: Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Frey
authors.affiliation: Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009519:New York City; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: breast augmentation; breast reconstruction; mastectomy; nipple-sparing mastectomy