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Optimizing Outcomes for Nipple Sparing Mastectomy Patients
M Asher Schusterman, Irene T Ma, Phoebe L Lee, Gretchen Ahrendt, Marguerite Bonaventura, Carolyn De La Cruz, Emilia J Diego, Ronald Johnson, Jennifer G Steiman, Priscilla F McAuliffe, Michael L Gimbel
University of Pittsburgh Medical Center
2019-02-15
Presenter: Irene Ma
Affidavit:
All of the work included in this abstract is original work by the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Nipple sparing mastectomy (NSM) can provide a woman with an optimal reconstructive aesthetic outcome. The use of a nipple delay (ND) procedure has been shown to improve viability of the nipple-areolar complex (NAC) in NSM patients, and the addition of breast reduction or mastopexy can convert less than optimal patients into better candidates for NSM.
Methods: Single-institution retrospective review of patients undergoing ND procedure in conjunction with NSM.
Results: Twenty-two women who underwent ND procedures with NSM were identified. The mean age at surgery was 47.3 (34-59) years. Bra sizes and ptosis grade ranged from A-D and 0-3, respectively. Three patients were former smokers, all >6 months from their last cigarette. Sixteen patients had genetic predisposition to breast cancer. The majority of patients (86%, 19/22) underwent bilateral NSM through an IMF incision (68%, 15/22). Seventeen patients had a breast reduction or mastopexy prior to ND and NSM. The average time between ND and NSM was 16 days (10-28). Reconstruction was direct-to-implant in 4 patients, autologous in 3 patients, and 2-stage using tissue expanders in 14 (subsequently 11 had implants placed, 2 had autologous reconstruction, and 1 had a latissimus dorsi flap/implant). One patient had a portion of her areola removed due to necrosis and one was noted to have DCIS on subareolar biopsy.
Discussion: A nipple delay procedure can be used in conjunction with breast reduction and mastopexy to assist in ensuring NAC viability and optimizing the results after a nipple sparing mastectomy in high risk women.
