title: Nipple-sparing mastectomy in patients with previous breast surgery: comparative analysis of 775 immediate breast reconstructions.
abstract: BACKGROUND
  An increasing number of women are candidates for nipple preservation with mastectomy. It is unclear how previous breast surgery impacts nipple-sparing mastectomy and immediate breast reconstruction.
  
  
  METHODS
  A single-institution retrospective review was performed between June of 2007 and June of 2013.
  
  
  RESULTS
  Four hundred forty-four patients underwent 775 immediate breast reconstructions after nipple-sparing mastectomy. Of these, 160 patients and 187 reconstructions had previous breast surgery, including 154 lumpectomies, 27 breast augmentations, and six reduction mammaplasties. Two hundred eighty-four patients with 588 reconstructions without previous breast surgery served as the control group. The previous breast surgery patients were older (49.6 years versus 45.8 years; p < 0.001) but otherwise had similar demographics. Previous breast surgery reconstructions were more often unilateral, therapeutic, and associated with preoperative radiotherapy (p < 0.001 for each). Extension of breast scars was common with previous breast surgery, whereas the inframammary incision was most frequent if no scars were present (p < 0.001). Multivariate regression analysis showed that previous breast surgery was not a significant risk factor for ischemic complications or nipple loss. Subgroup analysis showed extension of prior irradiated incisions was predictive of skin flap necrosis (OR, 9.518; p = 0.05). A higher number of lumpectomy patients had preoperative radiotherapy (41 versus 11; p < 0.001), and patients with breast augmentation had more single-stage reconstructions (85.2 percent versus 62.9 percent; p = 0.02).
  
  
  CONCLUSIONS
  Nipple-sparing mastectomy and immediate reconstruction can be performed in patients with prior breast surgery with no significant increase in nipple loss or ischemic complications.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Frederick
authors.forename: Alex M
authors.initials: AM
authors.lastname: Lin
authors.forename: Robert
authors.initials: R
authors.lastname: Neuman
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: William G
authors.initials: WG
authors.lastname: Austen
authors.forename: Amy S
authors.initials: AS
authors.lastname: Colwell
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States