title: The impact of breast mass on outcomes of total skin-sparing mastectomy and immediate tissue expander-based breast reconstruction.
abstract: BACKGROUND
  Larger breast size has been viewed as a relative contraindication for nipple/areola preservation with mastectomy. Few studies have directly evaluated the effect of quantified breast size on postoperative outcomes.
  
  
  METHODS
  The authors reviewed and assessed 325 total skin-sparing mastectomy cases performed in 224 patients with immediate tissue expander placement that had documented mastectomy specimen mass. Cases were divided into two groups based on having larger (>352 grams) or smaller (≤352 grams) breast mass.
  
  
  RESULTS
  Patients in the larger group had a mean body mass index that was 3.6 kg/m2 greater (p < 0.001). Overall, the larger group had an 8.1 percent increase in risk of superficial nipple necrosis (adjusted relative risk 4.0; 95 percent CI, 1.5 to 10.3). There were non-significant trends toward a 4.3 percent increase in risk of minor skin necrosis (adjusted relative risk 2.0; 95 percent CI, 0.7 to 6.4) and a 4.4 percent increase in risk of wound breakdown (adjusted relative risk 1.8; 95 percent CI, 0.8 to 3.7) with larger breast mass. Stratifying by radiation exposure, there was a non-significant trend toward a 5.4 percent increase in risk of wound breakdown (adjusted relative risk 2.9; 95 percent CI, 0.9 to 8.8) with larger breast mass in the stratum without radiation exposure.
  
  
  CONCLUSIONS
  Larger breast mass was associated with an increased risk of superficial nipple necrosis and trends toward increased risks of minor skin necrosis and wound breakdown. Larger breast mass was not associated with an increased risk of nipple or skin flap necrosis requiring operative management.
  
  
  METHODS
  Risk, II.
authors.affiliation: San Francisco, Calif. From the Division of Plastic and Reconstructive Surgery and the Carol Franc Buck Breast Care Center, Department of Surgery, University of California, San Francisco.
authors.forename: Frederick
authors.initials: F
authors.lastname: Wang
authors.forename: Michael
authors.initials: M
authors.lastname: Alvarado
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ewing
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.forename: Robert
authors.initials: R
authors.lastname: Foster
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
mesh_terms: D015992:Body Mass Index; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome