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Nipple reconstruction and radiation therapy: surgical techniques and complications
Isis Scomacao; Eliana Duraes; Pauline Vandijck; Humzah Quereshy; Nasim Abedi; Andrea Moreira; Steven Bernard; Risal Djohan; Graham Schwarz
Cleveland Clinic
2018-02-15
Presenter: Isis Scomacao
Affidavit:
I certify the project represents original work of the residents and authors on this project
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: To study the influence of radiation therapy, surgical techniques, and other factors on complications after nipple reconstruction
Method: A retrospective chart analysis was performed from patients that underwent different types of nipple reconstruction from 2009 to 2012. The information was collected per reconstructed nipple. Nipple complication was defined as any minor or major complication. Lack and excess of nipple projection and asymmetry were not included among the complications.
Results: A total of 350 patients had 520 nipples reconstructed. The most frequently used surgical techniques were: modified skate flap 228 (43.8%), skate flap 171 (32.9%), and C-V flap 60 (11.5%); which were combined with: skin grafts 232 (44.6%), cartilage 76(14.6%), and/or dermal fat grafts 46 (11.6%). Nipple complications were identified in 62 (11.9%) nipples, the most frequent being: partial necrosis 38 (7.3%); dehiscence 11 (2.1%); infection 8 (1.5%); and partial skin graft loss 3 (0.6%). The main reasons for reoperation were: nipple excess 20(3.8%); lack of projection 9 (1.7%); partial nipple necrosis 5 (1%); and asymmetry 3 (0.6%). The following factors were correlated to nipple complications (identified by univariate analysis and confirmed on a multivariate analysis): smoking status (p=0.028); radiation therapy (p=0.001); and reconstruction with skate flap (p=0.005).
Conclusion: Nipple reconstruction in smokers and radiated breast tissue present a higher rate of complications. Among the surgical techniques performed, the skate flap was an independent factor for surgical complications. However, variation in individual surgeons' technique appears to influence these results.
