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Risk Factors And Aesthetic Outcomes Following Abdominal-based Free Flap Breast Reconstruction After Nipple-sparing Mastectomy.
Paul Durand MD, Eliana Duraes MD, Jordan Gales BS, Steven Bernard MD, Risal Djohan MD, Andrea Moreira MD, Joao Batista de Sousa MD PhD, Graham Schwarz MD.
Cleveland Clinic Foundation
2014-03-15
Presenter: Paul Durand MD
Affidavit:
Above work represents original work of resident.
Director Name: Steven Bernard MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Objective:
To examine risk factors associated with major complications, as well as aesthetic outcomes following free tissue reconstruction after nipple-sparing mastectomy (NSM).
Methods:
Patients undergoing free tissue transfer after NSM at a single, tertiary-care institution from 2007 to 2014. Patient demographics, breast cancer history, complications, and reoperations were examined. Post-operative photographs were graded to evaluate aesthetic outcomes.
Results:
44 breasts (22 oncologic, 22 prophylactic) in 27 patients, with mean follow-up of 11.5 months. Forty DIEPs and four free-TRAMs. Mean BMI was 28.6. Mastectomy flap ischemia/necrosis was seen in 11 and 10 breasts, respectively. NAC ischemia/necrosis was seen in 14 and 8 breasts, respectively. Total reoperation rate was 22%. HTN was associated with higher rates of flap ischemia (p=0.02). BMI not associated with increased complications rates. Higher rates of NAC ischemia/necrosis were seen in breasts with smaller preoperative cup sizes (p=0.023,p=0.02). Indication for NSM (prophylactic vs. oncologic) was not associated with increase in complications or reoperations.
Mean aesthetic score across all categories was 4.2 out of 5. Lowest mean score was for nipple aesthetics at 3.8/5. Larger cup sizes had better aesthetic outcomes in four categories: volume (p=0.008), position (p=0.05), symmetry (p = 0.016), and nipple (p=0.002). Presence of NAC necrosis had no effect on nipple aesthetics.
Conclusion:
The present study identifies several risk factors associated with higher complication rates in free tissue reconstruction following NSM. Smaller cup sizes had higher rates of NAC ischemia/necrosis. NAC necrosis had no effect on nipple aesthetics. Overall aesthetic outcome was better in larger cup sizes.
