Breast reconstruction following nipple-sparing mastectomy: clinical outcomes and risk factors related complications.
BACKGROUND
The aim of this study was to investigate clinical outcomes and risk factors related complications in patients who had undergone nipple-sparing mastectomy (NSM) followed by implant-based or autologous reconstruction.


METHODS
Between 2004-2014 a single-institution retrospective review was collected on NSMs reconstruction. Patient demographics, comorbidities, breast morphological factors, type and timing of radiotherapy, type of incision, reconstruction type and timing, implant volume and complications were collected.


RESULTS
A total of 288 patients had undergone 369 NSMs, 81 (28.1%) of which were bilateral while 207 (71.9%) unilateral. One-hundred mastectomies were performed for prophylactic purposes whereas 269 were therapeutics. Thirteen (4.5%) patients were active smokers, while 2 (0.7%) were diabetics. Fifty-five breasts (14.9%) were previously irradiated and average time elapsed between radiotherapy and NSM was 9-year, (range, 5-15 yrs). Total complication rate was 13.5% at mean follow-up of 47.98 months (range, 6-114 months). Partial-thickness and full-thickness mastectomy skin flap and NAC necrosis occurred in 39 (78%) and in 10 (20%) breasts, respectively. Previous radiotherapy and implant volume were significant predictors of complications (OR: 10.14, 95% CI: 3.99-27.01; OR × 100 g: 3.13, 95% CI: 1.64-6.33). Overall mastectomy type incision was not predictive of complications (p = .426). No association was observed between radiotherapy and mastectomy type access (p = .349).


CONCLUSIONS
From our experience NSM followed by implant-based and autologous reconstruction had a relative high rate of complications comparable to previous reports. Despite this, it should be carefully offered to patients in whom potential risk factors are identified.
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Rosaria
R
Laporta
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Benedetto
B
Longo
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Michail
M
Sorotos
b Department of Public Health and Infectious Diseases , "Sapienza" University of Rome , Rome , Italy.
Alessio
A
Farcomeni
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Caterina
C
Patti
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Maria Rosaria
MR
Mastrangeli
c Department of Medicine and Surgery , Plastic Surgery Unit, University of Salerno, Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio e Ruggi d'Aragona , Salerno , Italy.
Corrado
C
Rubino
a Plastic Surgery Department , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy.
Fabio
F
Santanelli di Pompeo
D000328:Adult; D001940:Breast / Q000473:pathology; D019928:Breast Implantation / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013524:Surgical Flaps / Q000473:pathology; D016896:Treatment Outcome
Nipple-sparing mastectomy; breast cancer; radiotherapy; risk factors; smoking; surgical incision