gms | German Medical Science

43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

13.09. - 15.09.2012, Bremen

Microsurgical Breast Reconstruction for Nipple-Sparing Mastectomy

Meeting Abstract

  • presenting/speaker P.N. Broer - NYU, Plastische Chirurgie, New York, United States
  • N. Tanna - NYU, Plastische Chirurgie, New York, United States
  • K. Weichman - NYU, Plastische Chirurgie, New York, United States
  • C. Ahn - NYU, Plastische Chirurgie, New York, United States
  • R. Allen - NYU, Plastische Chirurgie, New York, United States
  • M. Choi - NYU, Plastische Chirurgie, New York, United States
  • N. Karp - NYU, Plastische Chirurgie, New York, United States
  • P. Saadeh - NYU, Plastische Chirurgie, New York, United States
  • J. Levine - NYU, Plastische Chirurgie, New York, United States

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen. Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen. 43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen (DGPR─C), 17. Jahrestagung der Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen (VD─PC). Bremen, 13.-15.09.2012. DŘsseldorf: German Medical Science GMS Publishing House; 2012. DocFV51

doi: 10.3205/12dgpraec062, urn:nbn:de:0183-12dgpraec0621

Published: September 10, 2012

© 2012 Broer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Background: Nipple-sparing mastectomy (NSM) warrants serious consideration and preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. The authors review their large volume experience with NSM and its reconstruction at a single institution. To our knowledge, this patient cohort represents the largest series of autologous breast reconstructions following nipple-sparing mastectomies.

Methods: All patients undergoing nipple-sparing mastectomy with microsurgical immediate breast reconstruction treated at NYU Medical Center, from 2007 to 2011, were identified. Patient demographics, breast cancer history, intraoperative details, complications, and revisionary surgeries were all examined. Descriptive statistical analysis was performed, and when appropriate, thettest or regression analysis utilized.

Results: In fifty-one patients, eighty-five free flap breast reconstructions (n=85) were performed. The majority of flaps were performed for prophylactic indications (n=55, 64.7%) and through periareolar incisions with vertical extension (n=40, 47.0%). The full spectrum of donor sites were used, including abdominally based (n= 66, 77.6%), profunda artery perforator (n=12, 14.1%), transverse upper gracilis (n=6, 7.0%), and superior gluteal artery perforator (n=1, 1.2%) flaps. The mean mastectomy specimen weight was 406.9▒186.5 grams (range 190 to 935 grams), while the mean flap weight was 481.7▒193.7 grams (range 192 to 1,010 grams). The most common complications were mastectomy skin flap necrosis (n=11, 12.7%) and nipple necrosis (n=11, 12.7%). There was no correlation between mastectomy skin flap or nipple necrosis and choice of incision, mastectomy specimen weight, BMI, or age (p>0.05). However, smoking history was associated with nipple necrosis (p 0.01).

Conclusions: This large series represents a high volume experience with nipple-sparing mastectomy followed by microsurgical reconstruction. When appropriately and safely executed, it can deliver high patient satisfaction, excellent aesthetic outcome, and low recurrence and complication rates. Factors that influence outcome include experience of the surgical team, choice of incision, breast size and ptosis, flap type, use of skin paddle, and method of postoperative free flap monitoring.