Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period.
BACKGROUND
Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study.


METHODS
Data extraction from the National Database was performed restricting cases to the 2009-2014 period. Different reconstruction procedures were analyzed in terms of their distribution over time and with respect to specific indications. A 1-year minimum follow-up was conducted to assess reconstructive unsuccessful events. Univariate and multivariate analyses were performed to investigate the causes of both prosthetic and autologous failures.


RESULTS
913 patients, for a total of 1006 procedures, are included in the analysis. A prosthetic only reconstruction is accomplished in 92.2 % of cases, while pure autologous tissues are employed in 4.2 % and a hybrid (prosthetic plus autologous) in 3.6 %. Direct-to-implant (DTI) reaches 48.7 % of all reconstructions in the year 2014. Prophylactic NSMs have a DTI reconstruction in 35.6 % of cases and an autologous tissue flap in 12.9 % of cases. Failures are 2.7 % overall: 0 % in pure autologous flaps and 9.1 % in hybrid cases. Significant risk factors for failures are diabetes and the previous radiation therapy on the operated breast.


CONCLUSIONS
Reconstruction following NSM is mostly prosthetic in Italy, with DTI gaining large acceptance over time. Failures are low and occurring in diabetic and irradiated patients at the multivariate analysis.
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Donato
D
Casella
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Claudio
C
Calabrese
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Lorenzo
L
Orzalesi
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Ilaria
I
Gaggelli
Statistics, Department of Statistics, Informatics and Application "G.Parenti", University of Florence, Viale Morgagni 59, 50134, Florence, Italy.
Lorenzo
L
Cecconi
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Caterina
C
Santi
Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, 71013, S.Giovanni Rotondo, Foggia, Italy.
Roberto
R
Murgo
Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, 70123, Bari, Italy.
Stefano
S
Rinaldi
Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, 27100, Pavia, Italy.
Lea
L
Regolo
Breast Unit Surgery, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
Claudio
C
Amanti
Breast Unit Surgery, Cisanello Hospital, Via Roma 67, 56123, Pisa, Italy.
Manuela
M
Roncella
Breast Unit Surgery, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.
Margherita
M
Serra
Breast Unit, Montecchio Maggiore Hospital, Via Ca' Rotte 7, 36075, Montecchio Maggiore, Vicenza, Italy.
Graziano
G
Meneghini
Breast Unit Surgery, Valdese Hospital, Via Pellico 19, 10125, Turin, Italy.
Massimiliano
M
Bortolini
Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy.
Vittorio
V
Altomare
Breast Unit Surgery, Businco Hospital, Via Jenner 1, 09127, Cagliari, Italy.
Carlo
C
Cabula
Breast Unit, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy.
Francesca
F
Catalano
Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy.
Alfredo
A
Cirilli
Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, 95126, Catania, Italy.
Francesco
F
Caruso
Breast Unit Surgery, Ramazzini Hospital, Via Molinari 2, 41012, Carpi (Modena), Italy.
Maria Grazia
MG
Lazzaretti
Radiation-Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Icro
I
Meattini
Radiation-Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
Lorenzo
L
Livi
President European Breast Centres Certification, President Senonetwork Italia Onlus, Florence, Italy.
Luigi
L
Cataliotti
Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy. marco.bern@tin.it.
Marco
http://orcid.org/0000-0002-9598-4860
M
Bernini
D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D016462:Mammaplasty / Q000379:methods* / Q000639:trends*; D015414:Mastectomy, Subcutaneous / Q000379:methods / Q000639:trends*; D009558:Nipples / Q000601:surgery; D012042:Registries; D013524:Surgical Flaps; D017211:Treatment Failure; D016896:Treatment Outcome
Autologous breast reconstruction; Breast reconstruction; Direct-to-implant; Nipple-sparing mastectomy; Tissue expander