Nipple Sparing Mastectomy in Patients With Prior Breast Scars: Is It Safe?. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Olson, Joshua; Anderson, Layla Ann; Ying, Jian; Zhang, Min-Min; Agarwal, Jayant P.
• Is Part Of: Annals of plastic surgery. Volume 78:Issue 1(2017:Jan.)
• Publication Date: 2017-01
• Subjects: nipple sparing mastectomy -- breast surgery -- nipple necrosis -- breast reconstruction -- postoperative outcomes; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000000818
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: Nipple-sparing mastectomy (NSM) preserves the native skin envelope, including the nipple-areolar skin, and has significant benefits including improved aesthetic outcome and psychosocial well-being. Patients with prior breast scars undergoing NSM are thought to be at increased risk for postoperative complications, such as skin and/or nipple necrosis. This study describes our experience performing NSM in patients who have had prior breast surgery and aims to identify potential risk factors in this subset of patients. Methods: A retrospective review of all patients undergoing nipple sparing mastectomy at The University of Utah from 2005 to 2011 was performed. Fifty-two patients had prior breast scars, for a total of 65 breasts. Scars were categorized into 4 groups depending on scar location: inframammary fold, outer quadrant, periareolar, and circumareolar. Information regarding patient demographics, social and medical history, treatment intent, and postoperative complications were collected and analyzed. Results: Eight of the 65 breasts (12%) developed a postoperative infection requiring antibiotic treatment. Tobacco use was associated with an increased risk of infection in patients with prior breast scars (odds ratio [OR], 7.95; 95% confidence interval [CI], 1.37–46.00; P = 0.0206). There was a 13.8% rate of combined nipple and skin flap necrosis and receipt of chemotherapy (OR, 5.00; CI, 1.11–22.46; P = 0.0357) and prior BCT (OR, 12.5; CI, 2.2–71.0; P = 0.004) were found to be associated with skin flap or NAC necrosis. Conclusions: Nipple-sparing mastectomy is a safe and viable option for patients with a prior breast scar. Our results are comparable to the published data in patients without a prior scar. Caution should be exercised with patients who have a history of tobacco use or those requiring chemotherapy because these patients are at increased risk for infection and NAC/skin flap necrosis, respectively, when undergoing NSM in the setting of a prior breast scar.