Nipple-Sparing Mastectomy in Patients with Previous Breast Surgery. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Frederick, Michael J.; Lin, Alex M.; Neuman, Robert; Smith, Barbara L.; Austen, William G.; Colwell, Amy S.
• Is Part Of: Plastic and reconstructive surgery. Volume 135:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000001283
• Languages: English
• ISSNs: 0032-1052

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>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.</p> </sec> <sec> <title>Methods:</title> <p>A single-institution retrospective review was performed between June of 2007 and June of 2013.</p> </sec> <sec> <title>Results:</title> <p>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; <italic>p</italic> < 0.001) but otherwise had similar demographics. Previous breast surgery reconstructions were more often unilateral, therapeutic, and associated with preoperative radiotherapy (<italic>p</italic> < 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 (<italic>p</italic> < 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; <italic>p</italic> = 0.05). A higher number of lumpectomy patients had preoperative radiotherapy (41 versus 11; <italic>p</italic> < 0.001), and patients with breast augmentation had more single-stage reconstructions (85.2 percent versus 62.9 percent; <italic>p</italic> = 0.02).</p> </sec> <sec> <title>Conclusion:</title> <p>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.</p> </sec> <sec> <title>CLINICAL QUESTION/LEVEL OF EVIDENCE:</title> <p>Therapeutic, III.</p> </sec> </abstract>