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Outcome Evaluation after Nipple Sparing Mastectomy with Abdominal Based Free Flap Breast Reconstruction: Our Experience
Cagri Cakmakoglu, MD, Joan Lee, BS, Isis Scomacao,MD, Hamzah Quereshy, BS, Andrea Moreira, MD, Risal Djohan, MD, Steven Bernard, MD, Eliana Duraes,MD, Graham Schwarz, MD
Cleveland Clinic
2019-02-15
Presenter: CAGRI CAKMAKOGLU
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Graham Schwarz, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
This report details the authors' experience performing nipple-sparing mastectomy with abdominal based free flap breast reconstruction.
Retrospective chart review was performed to identify the patients who underwent operations from 2006 to June of 2018 at a single institution. Demographics and outcomes were analyzed.
A total of 202 nipple-sparing mastectomies were performed on 121 patients. 81% of the patients underwent immediate, and 17% had delayed-immediate breast reconstruction. 52% of the patients had grade II ptosis, and 28% of them had stage 0 or I cancer. 46% of the patients had sentinel lymph node biopsy, and 10% of them had axillary lymphadenectomy. Only 20% of the patients received post-mastectomy radiotherapy, while 40% of them had chemotherapy. 40% of the mastectomies were performed with inframammary, and 25% of them with lateral incision. The total nipple necrosis rate was 3.4% after the first reconstruction attempt. The breast and donor site related complication rate in the first 30 days was 20% and 23% respectively. Most of the reconstructions were performed with deep inferior epigastric artery flap (88%). A mean of 1.1 revision surgery performed during reconstruction. A mean 2.76 surgery were performed during the reconstruction, and 0.69 surgeries required complication management. Nipple areola reconstruction was performed on 7% of the patients after total nipple necrosis. Reconstruction was abandoned in one patient. Two patients died during the follow-up.
The proper patient selection and well-executed operations are mandatory to limit complications. Outcomes are clearly dependent on surgical proficiency and some patient characteristics.
