Nipple-Sparing Mastectomy via an Inframammary Fold Incision with Implant-Based Reconstruction in Patients with Prior Cosmetic Breast Surgery.
BACKGROUND
Nipple-sparing mastectomy through an inframammary fold incision (NSM-IMF) with implant-based reconstruction (IBR) is a cosmetically preferable approach to breast cancer treatment in appropriate candidates. However, patients who have undergone prior cosmetic breast surgery (CBS) may be at increased risk for postoperative complications secondary to existing surgical scars.


OBJECTIVE
To assess whether prior CBS increases the risk of complications following NSM-IMF with IBR.


METHODS
A retrospective chart review was conducted for 398 NSM-IMFs with IBR performed between July 2006 and December 2013. CBS cases were identified. Outcomes were reviewed.


RESULTS
Of 398 NSM-IMF cases, 41 had prior CBS: 24 augmentations, 12 reductions, three mastopexies, and two augmentation mastopexies. NSM-IMF was performed an average of 8 years following CBS. CBS cases had lower BMIs (P = .040), more breast tissue resected (P = .021), wider breast bases (P = .0002), more single-stage reconstructions (P < .0001), more ADM use (P < .0001), and larger permanent implants (P = .0051) than those without CBS. Postoperatively, CBS cases had higher rates of mastectomy flap ischemia (P = .0392) and hematoma (P = .0335). Among CBS cases, single-stage reconstruction was associated with increased full-thickness flap ischemia (P = .0066). Compared to prior augmentation cases, prior reduction/mastopexy cases had higher rates of capsular contracture (P = .0409) and seroma (P = .0226).


CONCLUSIONS
This series is the largest to date to evaluate the success of NSM-IMF with IBR in CBS patients. These women should be cautiously considered for IBR, particularly in the setting of single-stage reconstruction.


METHODS
4 Therapeutic.
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Briar L
BL
Dent
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Christina N
CN
Cordeiro
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Kevin
K
Small
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Jessica A
JA
Clemons
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Evan G
EG
Kessler
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Alexander
A
Swistel
Dr Dent is a Resident and Dr Talmor is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York. Dr Cordeiro is a Resident, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Small is a Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Ms. Clemons is a Medical Student, Weill Cornell Medical College, Cornell University, New York, New York. Dr Kessler is a Resident, Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York. Dr Swistel is an Attending Surgeon and Associate Professor of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Mia
M
Talmor
D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D059351:Organ Sparing Treatments; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome