Nipple reconstruction in autologous breast reconstruction after areola-sparing mastectomy. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Opsomer, Dries; Vyncke, Tom; Depypere, Bernard; Stillaert, Filip; Van Landuyt, Koenraad; Blondeel, Phillip
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 74:Issue 6(2021)
• Page Start: 1223
• Page End: 1228
• Publication Date: 2021-06
• Subjects: Patient reported outcomes -- Microsurgery; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2020.10.082
• Languages: English
• ISSNs: 1748-6815

Abstract

Summary: Introduction: The number of patients requesting prophylactic mastectomy with immediate reconstruction is rising. The oncological safety of techniques preserving the nipple and/or areola complex is still controversial. Nevertheless, nipple-sparing mastectomy (NSM) and areola-sparing mastectomy (ASM) are becoming increasingly popular. After ASM, traditional nipple reconstruction techniques can be a disappointment and can lead to a deep groove around the new nipple. We describe a technique to overcome these issues and analyzed how three types of mastectomy (skin-sparing mastectomy or SSM, ASM, and NSM) compare to one another by looking into the number of wound infections, extra procedures for the loss of projection, nipple necrosis, and BREAST-Q scores. Methods: We retrospectively analyzed 467 breast reconstructions performed in 351 patients between 2011 and 2017 at the University Hospital of Gent. Patients were asked to fill out the BREAST-Q questionnaire and patient-reported outcomes were analyzed and correlated to demographic information. Results: Patients undergoing a nipple reconstruction after ASM are experiencing similar rates of wound problems, extra surgical procedures for the loss of projection and necrosis, compared to women with a history of SSM. When considering the " satisfaction with breast" and " satisfaction with outcome" modules of the BREAST-Q, we noted that nipple-sparing mastectomy (NSM) patients report lower scores than SSM and ASM patients and ASM patients seem to report a higher " satisfaction with nipple, " than the other two treatment groups. Conclusion: An ASM is a valuable alternative to a nipple-sparing mastectomy and leads to a good esthetic result and patient satisfaction.