title: Nipple-sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications?
abstract: BACKGROUND
  Reconstruction in the setting of prior breast irradiation is conventionally considered a higher-risk procedure. Limited data exist regarding nipple-sparing mastectomy in irradiated breasts, a higher-risk procedure in higher-risk patients.
  
  
  METHODS
  The authors identified and reviewed the records of 501 nipple-sparing mastectomy breasts at their institution from 2006 to 2013.
  
  
  RESULTS
  Of 501 nipple-sparing mastectomy breasts, 26 were irradiated. The average time between radiation and mastectomy was 12 years. Reconstruction methods in the 26 breasts included tissue expander (n=14), microvascular free flap (n=8), direct implant (n=2), latissimus dorsi flap with implant (n=1), and rotational perforator flap (n=1). Rate of return to the operating room for mastectomy flap necrosis was 11.5 percent (three of 26). Nipple-areola complex complications included one complete necrosis (3.8 percent) and one partial necrosis (3.8 percent). Complications were compared between this subset of previously irradiated patients and the larger nipple-sparing mastectomy cohort. There was no significant difference in body mass index, but the irradiated group was significantly older (51 years versus 47.2 years; p=0.05). There was no statistically significant difference with regard to mastectomy flap necrosis (p=0.46), partial nipple-areola complex necrosis (p=1.00), complete nipple-areola complex necrosis (p=0.47), implant explantation (p=0.06), hematoma (p=1.00), seroma (p=1.00), or capsular contracture (p=1.00).
  
  
  CONCLUSIONS
  In the largest study to date of nipple-sparing mastectomy in irradiated breasts, the authors demonstrate that implant-based and autologous reconstruction can be performed with complications comparable to those of the rest of their nipple-sparing mastectomy patients.
authors: New York, N.Y. From the New York University Medical Center.
authors: Michael
authors: M
authors: Alperovich
authors: Mihye
authors: M
authors: Choi
authors: Jordan D
authors: JD
authors: Frey
authors: Z-Hye
authors: ZH
authors: Lee
authors: Jamie P
authors: JP
authors: Levine
authors: Pierre B
authors: PB
authors: Saadeh
authors: Richard L
authors: RL
authors: Shapiro
authors: Deborah M
authors: DM
authors: Axelrod
authors: Amber A
authors: AA
authors: Guth
authors: Nolan S
authors: NS
authors: Karp
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D016896:Treatment Outcome