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Nipple Sparing Mastectomy with Autologous Tissue Reconstruction: A Review of the Literature and Our Institution's Experiences
Rebecca Knackstedt, MD, PhD
Ahmed Hashem, MD
Paul Durand, MD
Eliana Duraes, MD
Todd Baker, MD
Steven Bernard, MD
Andrea Moreira, MD
Risal Djohan, MD
Graham Schwarz, MD
Cleveland Clinic Foundation
2016-02-01
Presenter: Rebecca Knackstedt
Affidavit:
The program director is out of town and will verify as soon as he returns.
Director Name: Steven Bermard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Nipple sparing mastectomy (NSM) with autologous tissue transfer represents the pinnacle of reconstruction. Any complication that results in nipple areolar complex compromise negates the benefits of this procedure. There exists a paucity of literature on outcomes of NSM and autologous reconstruction.
Methods: A literature review on NSM reconstructed with autologous tissue was conducted in Pubmed, yielding 742 articles. Clinical studies involving nipple-sparing mastectomy with autogenous reconstruction were included and studies with potential patient overlap were excluded, resulting in four articles. Data points reflective of patient characteristics and reconstructive complications were investigated and compared to institutional results.
Results: From 2007 to 2014, our institution reconstructed 45 breasts with NSM and autologous tissue. The average patient age was 47 years with a BMI of 23. DIEP reconstruction was performed in 40/45 (88.9%) patients. Fat necrosis occurred in 2 (4.4%) breasts, infection in 4 (8.9%) breasts, seroma and hematoma each in 3 (6.7%) breasts and NAC necrosis in 5 (11.1%) breasts. This was compared to literature where the average age was 43.9 years with a BMI of 23.6. DIEP reconstruction was performed 195/279 (67.7%) breasts. Fat necrosis occurred in 7/134 (5.2%), infection in 11/182 (6%), seroma in 5/226 (2.2%), hematoma in 13/226 (5.8%) and NAC necrosis in 12/92 (5.2%).
Conclusion: Our results are comparable to literature in regards to patient characteristics and outcomes. With an analysis of literature and our outcomes, we have identified patient characteristics that may predict NSM and autologous reconstruction success.
