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Implant-based breast reconstruction after nipple sparing mastectomy: a comparison between one and two stages
Isis Scomacao
Thomas Xia
Jonathan Wyrick
Eliana Duraes
Joseph Yunis
Steven Bernard
Graham Schwarz
Andrea Moreira
Cleveland Clinic
2019-02-15
Presenter: Isis Scomacao
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Compare risk factors and complications in patients after nipple sparing mastectomy (NSM) and implant-based breast reconstruction.
Methods: A retrospective chart review was performed in a tertiary institution from 2016 to 2018. All patients that underwent NSM followed by 2 stages or direct to implant (DTI) reconstruction had their information collected per reconstructed breast. Patient demographics, previous surgeries, smoking status, radiotherapy history, surgical information and post-operative complications (delayed wound healing, dehiscence, mastectomy flap necrosis, and infection) were collected.
Results: A total of 217 breasts were analyzed, 110 (50.69%) underwent direct to implant and 107 (49.30%) two stages reconstructions. DTI group had patients with slightly older age: 48.88±12.78 vs 45.31±10.8 (p=0.02), higher BMI: 27.35±5.97 vs 24.89±4.95 (p=0.001) and higher mastectomy weight: 455.62±229.05g vs 372.213±213.06g (p=0.006). The groups were similar for smoking status, history of radiation, prophylactic mastectomy and grade III ptosis. DTI group had more pre-pectoral reconstructions than TE group; 65 (59.09%) vs 22 (20.56%), respectively. There were no significant differences in complication rates between the groups: 28.97% vs 33.63% (p=0.47), and reoperation rates: 12.14% vs 15.45% (p=0.56). Number of revision surgery was similar between both groups. Successful implant-based reconstructions were achieved in 90.81% on TE group and 96.36% on DTI group.
Conclusion: Implant-based breast reconstruction after nipple sparing mastectomy can be successfully achieved in one or two stages with similar complication and reoperation rates. The patients that underwent direct to implant reconstructions had similar rates of successful reconstructions, despite the higher BMI, older age and higher mastectomy specimens' weights.
