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Oncoplastic Nipple Sparing Mastecomy with Immediate, Implant-Based Reconstruction: Technique and Outcomes
Sarah E Sasor, Tyler A Evans, Michael W Chu, Sunil S Tholpady, Juan Socas
Indiana University
2016-01-31
Presenter: Sarah Sasor
Affidavit:
I certify that this abstract is the original work of my resident, Sarah Sasor. She was involved in all aspects of the project.
Director Name: Rajiv Sood
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Nipple sparing mastectomy (NSM) is a popular option for women with small, peripherally located breast tumors. The procedure is oncologically safe in select patients but can be technically challenging in large, ptotic breasts. In this study, we examine our experience with NSM using a Wise-pattern skin reduction and nipple areola complex (NAC) preservation on an inferiorly based adipo-dermal pedicle.
Methods
A retrospective study of patients undergoing NSM at our institution over a six month period was performed. All patients undergoing NSM with a Wise-pattern skin reduction, NAC repositioning, and immediate, implant-based breast reconstruction were included. Variables collected included patient demographics, smoking status, medical comorbidities and indication for mastectomy. Post-operative outcomes were analyzed with respect to patient and tumor characteristics.
Results
Eight NSM's were performed on five patients during the study period. Mean age and BMI were 49 years and 29.1, respectively. No patients were current smokers. All breasts had grade 2 or 3 ptosis. Mean mastectomy weight was 878 grams. All patients had immediate reconstruction with tissue expander (6) or implant (2) placement. One patient required take-back to the operating room for hematoma evacuation. Three NAC's demonstrated partial necrosis; all were successfully treated with local wound care. No NAC loss, T-junction breakdown, wound dehiscence, infection or implant extrusion/exposure was noted.
Conclusion
Wise-pattern skin incision with NAC repositioning and immediate, implant-based reconstruction is a safe and useful technique for managing large, ptotic breasts during NSM. In carefully selected patients, it has a high success rate and provides optimal aesthetic results.
