1
|
Henry N, Sebag V, Safran T, Viezel-Mathieu A, Dionisopoulos T, Davison P, Vorstenbosch J. Immediate Prepectoral Tissue Expander Breast Reconstruction Without Acellular Dermal Matrix Is Equally Safe Following Skin-Sparing and Nipple-Sparing Mastectomy. Ann Plast Surg 2024; 93:172-177. [PMID: 38775386 DOI: 10.1097/sap.0000000000003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND Prepectoral breast reconstruction has become increasingly popular over the last decade. There is a paucity of data surrounding the impact of mastectomy type on clinical outcomes when comparing prepectoral immediate breast reconstruction without acellular dermal matrix (ADM) using tissue expansion. The purpose of this study was to compare 90-day reconstructive surgical outcomes in immediate prepectoral tissue expander reconstruction between patients with nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM). METHODS A retrospective review of patient records was carried out on all patients undergoing NSM or SSM with immediate prepectoral tissue expander reconstruction without ADM, in a single institution, from June 2020 to December 2021. All complications were recorded, categorized, and statistically analyzed for significance. RESULTS Seventy-nine patients (97 breasts) were studied. The mean age was 51 years old (range, 31-77). Twenty-two patients suffered complications recorded in 22 breasts (22.7%). There was no statistically significant difference in the total complications between the NSM (25.7%) and SSM (21.0%) groups or in the incidence of all major and minor complications. CONCLUSIONS Breast reconstruction using tissue expanders without ADM has similar reconstructive outcomes in both NSM and SSM. There were no significant differences in complication rates between either groups. Breast reconstruction without ADM can confer institutional cost savings without compromising safety.
Collapse
Affiliation(s)
- Nader Henry
- From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Victoria Sebag
- McGill University, Faculty of Medicine, Montreal, Quebec, Canada
| | - Tyler Safran
- From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Tassos Dionisopoulos
- Division of Plastic and Reconstructive Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Peter Davison
- From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joshua Vorstenbosch
- From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Jones VM, Nelson JA, Sevilimedu V, Le T, Allen RJ, Mehrara BJ, Barrio AV, Capko DM, Heerdt AS, Tadros AB, Gemignani ML, Morrow M, Sacchini V, Moo TA. Impact of Mastectomy Flap Necrosis on Patient-Reported Quality-of-Life Measures After Nipple-Sparing Mastectomy: A Preliminary Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15681-3. [PMID: 38990221 DOI: 10.1245/s10434-024-15681-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 06/12/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Mastectomy skin flap necrosis (SFN) is common following nipple-sparing mastectomy (NSM), but studies on its quality-of-life (QOL) impact are limited. We examined patient-reported QOL and satisfaction after NSM with/without SFN utilizing the BREAST-Q patient-reported outcome measure (PROM) survey. PATIENTS AND METHODS Patients undergoing NSM between April 2018 and July 2021 at our institution were examined; the BREAST-Q PROM was administered preoperatively, and at 6 months and 1 year postoperatively. SFN extent/severity was documented at 2-3 weeks postoperatively; QOL and satisfaction domains were compared between patients with/without SFN. RESULTS A total of 573 NSMs in 333 patients were included, and 135 breasts in 82 patients developed SFN (24% superficial, 56% partial thickness, 16% full thickness). Patients with SFN reported significantly lower scores in the satisfaction with breasts (p = 0.032) and psychosocial QOL domains (p = 0.009) at 6 months versus those without SFN, with scores returning to baseline at 1 year in both domains. In the "physical well-being-of-the-chest" domain, there was an overall decline in scores among all patients; however, there were no significant differences at any time point between patients with or without SFN. Sexual well-being scores declined for patients with SFN compared with those without at 6 months and also at 1 year, but this did not reach significance (p = 0.13, p = 0.2, respectively). CONCLUSIONS Patients undergoing NSM who developed SFN reported significantly lower satisfaction and psychosocial well-being scores at 6 months, which returned to baseline by 1 year. Physical well-being of the chest significantly declines after NSM regardless of SFN. Future studies with larger sample sizes and longer follow-up are needed to determine SFN's impact on long-term QOL.
Collapse
Affiliation(s)
- V Morgan Jones
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiana Le
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah M Capko
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra S Heerdt
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
3
|
Serio F, Manna E, La Pinta M, Arienzo F, Costarelli L, Zarba Meli E, Loreti A, Mastropietro T, Broglia L, Ascarelli A, Apicella G, Rossi R, Piccolino G, Fortunato L. Intraoperative Examination of Retro-Areolar Margin is not Routinely Necessary During Nipple-Sparing Mastectomy for Cancer. Ann Surg Oncol 2023; 30:6488-6496. [PMID: 37391672 DOI: 10.1245/s10434-023-13726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/23/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Intraoperative examination of retro-areolar margin (IERM) often is used during nipple-sparing mastectomy (NSM) for cancer, but there is no robust data regarding its real advantage. METHODS Consecutive patients undergoing NSM for cancer with omission of IERM according to institutional protocols from 2016 to 2021 were retrospectively analyzed. The decision to maintain or remove the Nipple-Areola Complex (NAC) after definitive pathology was taken at the multidisciplinary meeting. RESULTS Among 162 women operated in the study period, the presence of neoplastic cells within 2 mm from the inked retroareolar margin (RAM) was detected at permanent pathology in 17 cases (10.5%). Nipple-Areola-Complex (NAC) was removed postoperatively in five patients (3%) for margins <1 mm, the other 12 were observed, whereas postoperative NAC necrosis required surgical removal in additional five cases (3%). The NAC was thus preserved in 152 of 162 patients (94%). At multivariate analysis, RAM ≤2 mm was associated with radiological tumor-to-nipple distance less than or equal to 1 cm (p = 0.04) and Ki67 label index ≥ 20 (p = 0.04), whereas multifocality/multicentricity showed a trend towards significance (p = 0.07). At a median follow-up of 46 months, five locoregional relapses occurred (3%), only one of them involving the NAC (0, 6%). Locoregional relapse and overall survival for patients with RAM > or < 2 mm were not different. CONCLUSIONS IERM is not routinely necessary during NSM for cancer, because its omission is associated with a very low return to the operating room, it is oncologically safe, and associated pitfalls are avoided. Further studies are necessary to confirm these findings.
Collapse
Affiliation(s)
- Francesca Serio
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Surgical Science, University of Rome "Tor Vergata", Rome, Italy
| | - Elena Manna
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy.
| | | | | | | | | | - Andrea Loreti
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Laura Broglia
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | | | - Rosalinda Rossi
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Gianmarco Piccolino
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Surgical Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy
| |
Collapse
|
4
|
Loreti A, Fanelli B, Abate O, Spallone D, Arelli F, Bruno E, Marcasciano M, La Pinta M, Meli EZ, Fortunato L. Surgical Delay of Nipple Areola Complex: A Powerful Technique to Extend the Indication of Nipple-Sparing Mastectomy. Clin Breast Cancer 2023; 23:255-264. [PMID: 36681577 DOI: 10.1016/j.clbc.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Surgical delay (SD) techniques, performed before the nipple sparing mastectomy (NSM), are procedures conceived to improve the blood supply to the nipple-areola complex (NAC) in order to overcome the ischemic risk. The aim of the study is reporting our experience with SD of the NAC in the setting of NSM, identify the rate of nipple and skin necrosis and other complications and to evaluate patient satisfaction with cosmetic outcome. PATIENTS AND METHODS A retrospective review of female patients, who underwent NSM and breast reconstruction between the July 2014 and the July 2019, was performed at the Breast Unit of San Giovanni-Addolorata Hospital in Rome. Eighty-nine NSM after SD procedure were performed in 66 patients. In all cases immediate breast reconstruction was performed with a direct to implant technique and polyurethane implants in prepectoral plan were used in all reconstructions. RESULTS We registered only 1 case of total NAC necrosis and 3 skin flap necrosis. Furthermore, patient satisfaction with breast reconstruction resulted excellent or good in 23 cases and good in 36 cases; the external plastic surgeon considered the breast reconstruction excellent or good in 63 cases. CONCLUSION We support the thesis that SD techniques may expand indications for NAC sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications. Microabstract This is the largest single center series on surgical delay of nipple areola complex providing interesting data on follow-up and complication rates and we support the thesis that surgical delay techniques may expand indications for nipple-areola complex sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications.
Collapse
Affiliation(s)
- Andrea Loreti
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
| | - Benedetta Fanelli
- Department of Surgery ''P.Valdoni'', Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ornella Abate
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Diana Spallone
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Floriana Arelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Edoardo Bruno
- Department of Surgery ''P.Valdoni'', Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco Marcasciano
- Division of Plastic and Reconstructive Surgery, Magna Grecia University of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Massimo La Pinta
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | | | - Lucio Fortunato
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| |
Collapse
|
5
|
Long AS, Ching AH, Hauc SC, Mozaffari MA, Junn AH, Rivera JC, Almeida MN, Alper DP, Allam O, Alperovich M. Flap to Mastectomy Mass: Are Higher Ratios Associated with Greater Breast Reconstruction Satisfaction? J Reconstr Microsurg 2023; 39:209-213. [PMID: 35752166 DOI: 10.1055/a-1885-1540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Autologous breast reconstruction is associated with superior patient-reported outcomes compared with prosthetic techniques, but little is known about the relationship between autologous flap mass and patient satisfaction. We hypothesized that a higher differential mass (ratio of flap mass to mastectomy mass) would be associated with greater satisfaction with reconstruction. METHODS In this retrospective study, patients who underwent autologous breast reconstruction between 2015 and 2020 with a deep inferior epigastric perforator (DIEP) flap completed the BREAST-Q survey. Multivariate linear regression models were used to examine the relationship between differential mass and patient satisfaction. Models controlled for body mass index (BMI), age at surgery, reconstruction size preference, number of surgeries, previous surgery failure, whether the patient underwent radiation therapy, and whether reconstruction was unilateral or bilateral. RESULTS Overall, 45 patients (70 breasts) completed the BREAST-Q survey. Mean age at reconstruction was 52.2 years and mean time to survey completion following surgery was 21.1 months. Most patients (59.4%) desired a smaller breast after reconstruction. The mean differential mass was +26.3% (flap mass greater than mastectomy mass). Differential mass was positively associated with all satisfaction measures with results being significant for satisfaction with breasts scores (p=0.032). CONCLUSION In this preliminary study, a higher ratio of autologous flap mass to mastectomy mass was associated with overall higher patient-reported satisfaction. A 1:1 flap to mastectomy mass ratio may not adequately reapproximate desired breast size or shape. Larger autologous flap mass may be favorable for long-term patient satisfaction, and future studies should investigate the relationship between differential mass and breast esthetics.
Collapse
Affiliation(s)
- Aaron S Long
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ann H Ching
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Sacha C Hauc
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Mohammad Ali Mozaffari
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Adam H Junn
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jean Carlo Rivera
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Mariana N Almeida
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - David P Alper
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Omar Allam
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
6
|
Zaborowski AM, Roe S, Rothwell J, Evoy D, Geraghty J, McCartan D, Prichard RS. A systematic review of oncological outcomes after nipple-sparing mastectomy for breast cancer. J Surg Oncol 2023; 127:361-368. [PMID: 36208279 DOI: 10.1002/jso.27115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Nipple-sparing mastectomy is an alternative to skin-sparing mastectomy in select patients. Increasing evidence supports its use in the setting of breast cancer, however concerns still exist regarding oncological safety. The aim of this systematic review was to evaluate long-term oncological outcomes of patients who underwent nipple-sparing mastectomy for breast cancer. A systematic review of the literature was performed to evaluate oncological outcomes in patients with breast cancer who underwent nipple-sparing mastectomy. Five major databases (PubMed, Embase, Scopus, Web of Science and Cochrane) were searched. The review included all original articles published in English reporting long-term oncological outcomes. 2334 studies were identified. After applying inclusion and exclusion criteria, 17 retrospective studies involving 7107 patients were included. The indication for nipple-sparing mastectomy was invasive carcinoma in 6069 patients (85.4%) and in situ disease in 1038 (14.6%). Median follow up was 48 months (range 25-94). The weighted mean rates of local recurrence and recurrence involving the nipple-areola complex were 5.4% (0.9-11.9) and 1.3% (0-4.9), respectively. The weighted mean distant failure rate was 4.8% (1.5-23.0). Therapeutic nipple-sparing mastectomy is oncologically safe in select patients with breast cancer.
Collapse
Affiliation(s)
- Alexandra M Zaborowski
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Simon Roe
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| |
Collapse
|
7
|
Kokosis G, Stern CS, Shamsunder MG, Polanco TO, Patel VM, Slutsky H, Morrow M, Moo TA, Sacchini V, Coriddi M, Cordeiro PG, Matros E, Pusic A, Disa JJ, Mehrara BJ, Nelson JA. Nipple-Sparing Mastectomy and Immediate Reconstruction: A Propensity Score-Matched Analysis of Satisfaction and Quality of Life. Plast Reconstr Surg 2022; 150:1214e-1223e. [PMID: 36103660 PMCID: PMC9712179 DOI: 10.1097/prs.0000000000009695] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although it is intuitive that nipple-sparing mastectomy in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life are limited and show mixed results. This study aimed to use a propensity score-matching analysis to compare satisfaction and health-related quality-of-life outcomes in patients who underwent implant-based reconstruction following bilateral nipple-sparing mastectomy or skin-sparing mastectomy. METHODS A propensity score-matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing nipple-sparing or skin-sparing mastectomy with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, body mass index, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications. RESULTS The authors examined 1371 patients for matching and included 460 patients (nipple-sparing mastectomy, n = 230; skin-sparing mastectomy, n = 230) in the final analyses. The authors found no significant differences in baseline, cancer, and surgical characteristics between matched nipple-sparing and skin-sparing mastectomy patients, who also had similar profiles for surgical complications. Interestingly, the authors found that postoperative Satisfaction with Breasts scores and all other health-related quality-of-life domains were stable over a 3-year period and did not differ significantly between the two groups. CONCLUSIONS Compared with skin-sparing mastectomy, bilateral nipple-sparing mastectomy did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that nipple-sparing mastectomy may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following nipple-sparing mastectomy warrant further investigation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- George Kokosis
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carrie S. Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meghana G. Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thais O. Polanco
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaidehi M. Patel
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hanna Slutsky
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York NY
| | - Tracy-Ann Moo
- Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York NY
| | - Virgilio Sacchini
- Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York NY
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter G. Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
8
|
Discussion: Oncologic Safety of Staged Prepectoral Implant Reconstruction following Nipple-Sparing Mastectomy: A Mean 9-Year Follow-Up. Plast Reconstr Surg 2022; 150:523-525. [PMID: 36040996 DOI: 10.1097/prs.0000000000009480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Huang W, Qiu Z, Mu T, Li X. A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer. Front Surg 2022; 9:923554. [PMID: 36034380 PMCID: PMC9403123 DOI: 10.3389/fsurg.2022.923554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background At present, the indication for nipple-sparing mastectomy (NSM) remains inconclusive, and occult nipple involvement (NI) is one of the most important problems when carrying out NSM. Therefore, we aimed to identify the predictive factors of NI, to provide a tool for selecting suitable candidates for NSM. Methods In this retrospective study, a total of 250 breast cancer patients who received mastectomy were recruited, and the association between NI and tumor clinicopathologic characteristics was investigated. Nipple signs, tumor size measured by ultrasound (US), and tumor location were developed as a nomogram to predict NI. Results Among the 250 patients, 34 (12.6%) had NI, and 216 (86.4%) did not. In the training group, NI was associated with nipple signs, tumor size, tumor–nipple distance (TND), tumor location, lymph node metastasis, and HER2 overexpression. Both in the training and in the validation groups, NI showed a significant association with nipple signs, tumor size measured by ultrasound, and tumor location. Based on these three clinical factors, the preoperative model nomogram was proved to have high efficiency in predicting NI, possessing a sensitivity of 80.0% and a specificity of 86.7% in the validation group. Conclusions We proposed a predictive model nomogram utilizing preoperative tumor characteristics, including nipple signs, tumor size measured by ultrasound, and tumor location. This predictive model could help in the planning of nipple-sparing mastectomy.
Collapse
Affiliation(s)
- Weiling Huang
- Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhikun Qiu
- Department of Breast Surgery, Huizhou Central People's Hospital, Huizhou, China
| | - Tai Mu
- Department of Thyroid and Breast Surgery, The First People's Hospital of Kashgar, Xinjiang, China
| | - Xi Li
- Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Surgery, Nyingchi People's Hospital, Nyingchi, China
- Correspondence: Xi Li
| |
Collapse
|
10
|
Wetzel CL, Gardiner SK, Johnson N, Garreau JR, Sutton TL. Variation in adoption of skin and nipple sparing mastectomy: An opportunity to enhance patient outcomes. Am J Surg 2022; 224:710-715. [DOI: 10.1016/j.amjsurg.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/25/2022] [Accepted: 05/20/2022] [Indexed: 11/01/2022]
|
11
|
Schusterman MA, Bruce MK, Nicholas K, Diego E, La Cruz CD. Galactorrhea After Nipple-Sparing Mastectomy: Case Report, Review of the Literature, and Algorithmic Approach to Management. Ann Plast Surg 2022; 88:467-469. [PMID: 34724440 DOI: 10.1097/sap.0000000000003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Nipple discharge is a rare but possible occurrence after nipple-sparing mastectomy (NSM). This study presents the first case of galactorrhea in a female patient after NSM. Although milky discharge due to physiologic lactation related to pregnancy is more common, galactorrhea is still possible and should be worked up appropriately to ensure that all breast tissue has been removed and that there are no other more worrisome causes.
Collapse
Affiliation(s)
| | | | | | - Emilia Diego
- Division of Breast Surgical Oncology, Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | |
Collapse
|
12
|
Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion in Nipple/Skin-Sparing and Skin-Reducing Mastectomies with Implant-Based Breast Reconstruction. Breast J 2022; 2022:5142100. [PMID: 35711883 PMCID: PMC9187268 DOI: 10.1155/2022/5142100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022]
Abstract
Methods Consecutive women scheduled for nipple/skin-sparing/skin-reducing mastectomy between May 2020 and April 2021 were prospectively enrolled. Patients were divided into Group 1 in the absence of superficial and full-thickness necrosis (SN; FTN) and Group 2 in the presence of both. T1 (time between ICG injection and the initial perfusion of the least perfused MSF area), ICG-Q1, and ICG-Q% (absolute and relative perfusion values of the least vascularized area) were collected. Results 38 breasts were considered. FTN was reported in 4 breasts (10.5%) and SN in 3 (7.9%). The two groups statistically differ in T1 (Group2 > Group1) and ICG-Q% (Group1 > Group2) (p < 0.05). T1 could statistically predict ICG-Q1 and ICG-Q%. Both quantitative values have a sensitivity of 57% and a NPV of 89%; ICG-Q% shows higher specificity (81% vs 77%) and PPV (40% vs 36%). Conclusions Quantitative ICG angiography may additionally reduce MSF necrosis. Moreover, longer T1 may indicate possible postoperative necrosis. Considering these factors, intraoperative changes of reconstructive strategy could be adopted to reduce reconstructive failure.
Collapse
|
13
|
Creating a Biological Breast Implant with an Omental Fat-Augmented Free Flap. Plast Reconstr Surg 2022; 149:832-835. [PMID: 35103642 DOI: 10.1097/prs.0000000000008963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Women with inadequate myocutaneous or fasciocutaneous soft-tissue donor sites for breast reconstruction after mastectomy are mostly limited to implants. Alternative substitutes are needed for those who do not want-or in whom there are contraindications for-implant-based reconstruction. The authors report a novel technique using an omental fat-augmented free flap to create an autologous breast mound that has comparable shape and projection to a breast implant. Three patients with breast cancer who desired unilateral reconstruction were identified in the period 2019 to 2020. All had insufficient traditional autologous sites and were averse to the use of implants. A nipple-sparing mastectomy was performed, and the omentum was laparoscopically harvested and fat-grafted ex vivo and then encased in acellular dermal matrix for microvascular anastomoses. The body mass indexes of the three patients were 17.6, 25, and 28.3 kg/m2. Each individual's mastectomy specimens and corresponding omentum plus fat-grafting weights were 113.7/228, 271/293, and 270/360 g. No postoperative complications occurred. The reconstructed breast remains soft, with stable breast volume at 6 months and without evidence of fat necrosis. This novel use of fat grafting into an omental flap enveloped in acellular dermal matrix, the omental fat-augmented free flap, provides a viable and successful autologous alternative for patients who are not candidates for traditional autologous breast reconstruction options because of body habitus or personal preference.
Collapse
|
14
|
The Importance of Fifth Anterior Intercostal Vessels following Nipple-Sparing Mastectomy. Plast Reconstr Surg 2022; 149:559-566. [PMID: 35006210 DOI: 10.1097/prs.0000000000008828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors describe the vascular anatomy of the fifth anterior intercostal artery perforator and its role for perfusion of the nipple-areola complex following nipple-sparing mastectomy. METHODS Twenty fresh cadavers were injected with 20 cc of colored latex through the internal mammary artery. The catheter was placed at the level of the second intercostal space after removal of the rib. The fifth intercostal space was dissected under magnification to observe the origin and trajectory of the fifth anterior intercostal artery perforator. Six selective computed tomographic angiograms of the fifth intercostal artery perforator were performed. A clinical case of nipple-sparing mastectomy in a woman with mammary hypertrophy is provided to demonstrate the utility of preserving the fifth anterior intercostal artery perforator. RESULTS The fifth anterior intercostal artery perforator was consistently observed in all the cases and confirmed by angiography. The perforator gives rise to several branches that traverse in all directions. The ascending branches of the fifth anterior intercostal artery perforator are directed toward the nipple-areola complex and course within the subcutaneous layer between the skin and the parenchyma. The fourth and fifth anterior intercostal artery perforators are independent of one another. CONCLUSION The main ascending branch of the fifth anterior intercostal artery perforator reaches the nipple-areola complex by the subcutaneous tissue independent of the Würinger fascia.
Collapse
|
15
|
Athamnah M, Rabai NA, Shkoukani ZW, Al Azzam HS, Abu-Shanab A. Nipple-Sparing Mastectomy: Initial Experience Evaluating Patients Satisfaction and Oncological Safety in a Tertiary Care Centre in Jordan. Cureus 2021; 13:e19238. [PMID: 34877215 PMCID: PMC8642139 DOI: 10.7759/cureus.19238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Nipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety. Methods and results Four nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%. Conclusion Following nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.
Collapse
Affiliation(s)
- Mohammad Athamnah
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Nimah A Rabai
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | | | - Hussein S Al Azzam
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Amer Abu-Shanab
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, JOR
| |
Collapse
|
16
|
Fiser C, Crystal JS, Tevis SE, Kesmodel S, Rojas KE. Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors. BREAST CANCER: TARGETS AND THERAPY 2021; 13:701-709. [PMID: 34938117 PMCID: PMC8687859 DOI: 10.2147/bctt.s321721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Caroline Fiser
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Jessica S Crystal
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Kesmodel
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Kristin E Rojas
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
- Correspondence: Kristin E Rojas Dewitt Daughtry Department of Surgery, University of Miami, 1295 NW 14th Street, Miami, FL, 33136, USATel +1 305 243-0783 Email
| |
Collapse
|
17
|
Fu M, Chen Q, Zeng L, Hong T, Zou Q, Yuan Y, Yi W. Prognosis Comparison Between Nipple-Sparing Mastectomy and Total Mastectomy in Breast Cancer: A Case-Control Study After Propensity Score Matching. Ann Surg Oncol 2021; 29:2221-2230. [PMID: 34802105 PMCID: PMC8933300 DOI: 10.1245/s10434-021-11044-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022]
Abstract
Background Currently, the operation rate of nipple-sparing mastectomy (NSM) is increasing. However, the long-term prognosis of NSM is not well documented. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term prognosis of NSM compared with total mastectomy (TM). Methods Population-level data of female breast cancer patients treated with NSM and TM were extracted from 1998 to 2016 from the SEER database. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables in comparisons. Kaplan-Meier analysis, log-rank test, and Cox proportional hazard regression were performed. Results A total of 5765 patients underwent NSM, which increased from 266 in 2004–2009 to 5370 in 2010–2016. A total of 134,528 patients underwent TM, and the number of patients undergoing TM continued to decline. The overall survival (OS) and breast cancer-specific survival (BCSS) were similar between the NSM group and the TM group (P = 0.058 and 0.87, respectively). For OS, subgroup analysis showed that patients with age ≥ 46, White race, median household income ≥ $70,000, hormone receptor-positive, and HER2 negative had a better prognosis for treatment with NSM. There was no significant difference in BCSS between the NSM group and the TM group. Conclusions In recent years, the clinical application of NSM has been increasing. NSM is a proper procedure for breast cancer patients to achieve long-term survival. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11044-4.
Collapse
Affiliation(s)
- Mengdie Fu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liyun Zeng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Hong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
18
|
Joo JH, Ki Y, Kim W, Nam J, Kim D, Park J, Kim HY, Jung YJ, Choo KS, Nam KJ, Nam SB. Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review. Gland Surg 2021; 10:2037-2046. [PMID: 34268088 DOI: 10.21037/gs-21-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
Background This study aimed to describe the locations of local recurrences based on the mastectomy and reconstruction type in breast cancer patients. Methods In November 2020, a systematic literature review was performed through MEDLINE/PubMed and the Cochrane Centre Register of Controlled Trials. Publications that included skin-sparing or nipple-sparing mastectomy followed by breast reconstruction and described the location of local recurrences were analyzed. Exclusion criteria included salvage or prophylactic mastectomy, unclear distinction between local and regional recurrences, rare tumor types. Results From 19 publications, 272 local recurrences lesions were reported in a total of 4,787 patients. After autologous reconstruction (n=2,465), local recurrences were located in the skin in 45 (1.8%) patients, in the chest wall in 18 (0.7%), and in the nipple-areolar complex in 9 (0.4%). After implant reconstruction (n=1,917), local recurrences sites included the skin in 91 (4.7%) patients, chest wall in 8 (0.4%), and nipple-areolar complex in 8 (0.4%). Of the 70 lesions with reported in-breast location, 57 (81.4%) relapsed in the original tumor location. Discussion Although meta-analysis was not conducted, present analysis demonstrated that most local recurrences after skin-sparing or nipple-sparing mastectomy occurred within the skin or subcutaneous tissues. It was found that the original tumor location was the most frequent site of relapse. Therefore, special attention should be paid to the original tumor overlying the skin while planning postmastectomy radiation therapy.
Collapse
Affiliation(s)
- Ji Hyeon Joo
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Donghyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jongmoo Park
- Department of Radiation Oncology, Kyungbook National University Chilgok Hospital, Daegu, Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
19
|
Lao N, Brackstone M, Formenti SC, Doherty C, Perera F, Chow R, DeLyzer T, Grant A, Boldt G, Lock M. Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk. Clin Transl Radiat Oncol 2021; 29:33-39. [PMID: 34113723 PMCID: PMC8170417 DOI: 10.1016/j.ctro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/12/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022] Open
Abstract
Breast cancer recurrences deep to pectoralis are very rare after mastectomy. Post-mastectomy chest wall radiation should exclude deep chest wall structures. Radiation after immediate implant reconstruction increases complications. Post-mastectomy radiation should target subcutaneous tissues and pectoralis major.
Introduction Most studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrence. Chest wall radiation-related fibrosis has become an important clinical consideration in the era of immediate implant-based breast reconstruction. In patients with commonly performed subpectoral implant-based reconstruction, the pectoralis major becomes relocated anterior to the implant and just deep to skin, therefore raising the question of value in radiating deep chest wall structures. This study assessed the rate of recurrence in each anatomical region of chest wall in post-mastectomy patients. Methods A comprehensive breast cancer database of 4287 patients at a single regional cancer center from 2006 to 2018 was retrospectively analyzed to identify 1571 mastectomy patients. Recurrences were classified as local skin/subcutaneous, pectoralis muscle (pectoralis major), deep chest wall (pectoralis minor, intercostal muscle or rib) or regional axillary recurrence. Results A total of 26 patients with locoregional recurrence were identified. Most recurrences were in the skin/subcutaneous level. Of 1571 mastectomy patients, only one patient developed a local recurrence posterior to pectoralis major. Our literature search and meta-analysis revealed that local recurrences post-mastectomy are much more likely to be in subcutaneous tissues/pectoralis major versus deeper chest wall. Conclusion A reduced clinical target volume which encompasses skin/subcutaneous and pectoralis muscle layers without treating deep chest wall may be more appropriate to reduce radiation-associated toxicity since avoiding circumferential radiation of an implant may prevent capsular contracture without compromising treatment benefit.
Collapse
Affiliation(s)
- Nicholas Lao
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Muriel Brackstone
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada.,Div General Surgery, London Health Sciences Centre, London, ON, Canada
| | | | - Christopher Doherty
- Div Plastic & Reconstructive Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Francisco Perera
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Ronald Chow
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Tanya DeLyzer
- Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - Aaron Grant
- Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - Gabriel Boldt
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Michael Lock
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| |
Collapse
|
20
|
Lee J, Park HS, Lee H, Lee DW, Song SY, Lew DH, Kim JY, Park S, Kim SI. Post-Operative Complications and Nipple Necrosis Rates Between Conventional and Robotic Nipple-Sparing Mastectomy. Front Oncol 2021; 10:594388. [PMID: 33489893 PMCID: PMC7819886 DOI: 10.3389/fonc.2020.594388] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose This study is to directly compare surgical outcomes between conventional nipple-sparing mastectomy (CNSM) and robot-assisted nipple-sparing mastectomy (RNSM). Materials and Method For this case–control study, 369 cases of 333 patients who underwent CNSM or RNSM with immediate reconstruction between November 2016 and January 2019 at Severance Hospital in Seoul, Republic of Korea were reviewed. Patients with stage IV breast cancer (n = 1), receiving neoadjuvant chemotherapy (n = 43), or subjected to previous operations (n = 14) or radiotherapy on the breasts were excluded. The main outcomes were comparing rates of post-operative complications, of high-grade post-operative complications as defined by the Clavien-Dindo classification, and nipple necrosis between the CNSM and the RNSM groups. Results A total of 311 cases, including 270 CNSMs and 41 RNSMs, were analyzed. The rates of post-operative nipple necrosis (p = 0.026, 2.4 vs. 15.2%) and of high-grade post-operative complications (p = 0.031, 34.8 vs. 17.1%) in the RNSM group were significantly lower than those in the CNSM group. Conclusion RNSM was associated with lower rates of high-grade post-operative complications and nipple necrosis than CNSM for patients with small breast volumes and less ptotic breasts.
Collapse
Affiliation(s)
- Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Haemin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
21
|
Yamashita Y, Tsunoda H, Nagura N, Kajiura Y, Yoshida A, Takei J, Suzuki K, Watanabe T, Iwahira Y, Yamauchi H, Hayashi N. Long-Term Oncologic Safety of Nipple-Sparing Mastectomy With Immediate Reconstruction. Clin Breast Cancer 2021; 21:352-359. [PMID: 33526379 DOI: 10.1016/j.clbc.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND We assessed the long-term oncologic safety of nipple-sparing mastectomy (NSM) compared to skin-sparing mastectomy (SSM) for primary breast cancer patients with immediate reconstruction. PATIENTS AND METHODS Data of stage 0-III primary breast cancer patients undergoing NSM (n = 190) or SSM (n = 729) from June 2006 to December 2012 were retrospectively collected. Nipple-tumor distance (NTD) was measured on pretreatment mammography, magnetic resonance imaging, or ultrasonography findings. NSM patients with NTD < 1 cm were excluded. Locoregional recurrence (LRR) rates were compared between groups. Disease-free survival (DFS) and overall survival (OS) according to surgical procedure were assessed. RESULTS The median (range) follow-up period for NSM and SSM was 71 (10-131) months and 79 (9-140) months, respectively. LRR developed in 11 patients with invasive ductal carcinoma (5.8%) for NSM and 44 (42 in patients with invasive ductal carcinoma and 2 in patients with ductal carcinoma-in-situ) (6.0%) for SSM. Hormone receptor and HER2 status were not associated with LRR in either group. DFS and OS rates did not differ between groups (DFS: 89.3% for NSM, 89.3% for SSM, P = .87; OS: 98.4% for NSM, 94.5% for SSM, P = .43). CONCLUSION NSM with immediate reconstruction was as safe as SSM for primary breast cancer with respect to prognosis and local control, regardless of the presence of invasive carcinoma or breast cancer subtype.
Collapse
Affiliation(s)
- Yuji Yamashita
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Hiroko Tsunoda
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Naomi Nagura
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Yuka Kajiura
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Koyu Suzuki
- Department of Pathology, St Luke's International Hospital, Tokyo, Japan
| | | | - Yoshiko Iwahira
- Department of plastic surgery, Breast Surgery Clinic, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan; Department of Breast Surgery, Watanabe Hospital, Tokyo, Japan.
| |
Collapse
|
22
|
Ozgur I, Kurul S, Bademler S, Karanlik H. Comparison of subpectoral versus dual-plane implant based immediate breast reconstruction after nipple-areola sparing mastectomy. ANN CHIR PLAST ESTH 2020; 66:447-458. [PMID: 33223365 DOI: 10.1016/j.anplas.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Selection of implant pocket and size is a dilemma for surgeons especially if radiation therapy is envisaged after implant based immediate breast reconstruction (IBR). The aim of this study is to compare complication rates between subpectoral and the dual plane polyglactin mesh supported IBR after nipple-areola sparing mastectomy. PATIENTS AND METHOD Reconstructive analysis of 208 breasts of 190 patients with breast cancer undergoing implant based IBR at a single university hospital were evaluated. The patients were reconstructed with either dual-plane polyglactin mesh supported (n=91) or subpectoral (n=117) implant based IBR after nipple-areola sparing mastectomy. Demographic data, and postoperative complications were compared. RESULTS The mean age was 43.3 years. Early complications encountered in 12% (n=25) and late complications occurred in 18% (n=37) of breasts. Both early (13,7% vs 9.9%, P=0.406) and late complications (24.8% vs 8.8%, P=0.003) were more common in subpectoral group, but only late complication occurrence rate was statistically significant. Capsular contracture (P=0.000), inframammary fold problems (P=0.010), bottoming-out (P=0.370), mechanical shift (P=0.036) and animation deformity (P=0.007) were all more common in subpectoral group. Only rippling deformity (P=0.011) was more common in dual plane group. CONCLUSIONS Dual plane IBR has acceptable complication rates compared to subpectoral IBR. It is associated with less capsular contracture, fewer animation and bottoming-out deformity and better inframammary fold appearance.
Collapse
Affiliation(s)
- I Ozgur
- Department of General Surgery, Fatih, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey.
| | - S Kurul
- Division of Plastic and Reconstructive Surgery, Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - S Bademler
- Division of Breast Surgery, Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - H Karanlik
- Division of Breast Surgery, Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| |
Collapse
|
23
|
Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Based on Tissue-Engineering Principles. Plast Reconstr Surg 2020; 146:409e-413e. [DOI: 10.1097/prs.0000000000007172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Elmore LC, Dietz JR, Myckatyn TM, Margenthaler JA. The Landmark Series: Mastectomy Trials (Skin-Sparing and Nipple-Sparing and Reconstruction Landmark Trials). Ann Surg Oncol 2020; 28:273-280. [PMID: 32886286 DOI: 10.1245/s10434-020-09052-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
Despite advances in medical therapy, the foundation of breast cancer treatment is surgery. The landscape of operative intervention for breast cancer has shifted toward less invasive techniques, resulting in improved cosmesis and lower morbidity while maintaining oncologic integrity. In this article, we review the body of literature contributing to landmark advances in mastectomy for the treatment of breast cancer.
Collapse
Affiliation(s)
- Leisha C Elmore
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill R Dietz
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Terence M Myckatyn
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
25
|
Park S, Yoon C, Bae SJ, Cha C, Kim D, Lee J, Ahn SG, Roh TS, Kim YS, Jeong J. Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction. Breast 2020; 53:85-91. [PMID: 32653836 PMCID: PMC7375566 DOI: 10.1016/j.breast.2020.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR. Methods We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis. Results Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis. Conclusions Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple. Periareolar incision shows higher complication rate in nipple-sparing mastectomy. Periareolar incision is a risk factor for nipple-areolar complex necrosis. Other risk factors include tumor-nipple distance and breast weight.
Collapse
Affiliation(s)
- Soeun Park
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Surgery, CHA Ilsan Medical Center, CHA University, Goyang, South Korea
| | - Changik Yoon
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Soong June Bae
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chihwan Cha
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dooreh Kim
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Janghee Lee
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Gwe Ahn
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Seok Kim
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Jeong
- Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
26
|
Wang M, Huang J, Chagpar AB. Is nipple sparing mastectomy associated with increased complications, readmission and length of stay compared to skin sparing mastectomy? Am J Surg 2020; 219:1030-1035. [DOI: 10.1016/j.amjsurg.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
|
27
|
Inframammary Fold Incision Can Reduce Skin Flap Necrosis in Immediate Breast Reconstruction With Implant and Conjoined Fascial Flap. Ann Plast Surg 2020; 85:488-494. [PMID: 32332387 DOI: 10.1097/sap.0000000000002393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immediate breast reconstruction with implant (IBRI) can produce good aesthetic results after nipple-sparing mastectomy (NSM). Various surgical incisions can be used for NSM. The purpose of this study is to compare outcomes of using an IBRI with dual-coverage fascial flap after NSM with an inframammary fold (IMF) or a radial (Rd) incision. METHODS We retrospectively reviewed the records of 88 women who underwent IBRI with dual-coverage fascial flap from March 2015 to June 2018. Inframammary fold incision was used in 19 patients (22 breasts) and Rd incision in 69 patients (75 breasts). In the dual-coverage method, acellular dermal matrix covered the inferomedial quadrant of the breast, and conjoined fascial flap covered the remaining inferolateral quadrant. Patient-reported satisfaction was assessed using the Breast-Q questionnaire, and plastic surgeons assessed aesthetic postoperative scores. RESULTS Complications and reoperation rates of 2 incisions were as follows: skin flap necrosis rate showed significant difference between 2 groups (IMF, 0.0% [0/22]; Rd, 16.0% [12/75]; P < 0.05). The other complication rates, hematoma, seroma, infection, capsular contracture, and total reoperations showed no significant difference. Postoperative Breast-Q scores were higher in the IMF group (331.9 ± 10.1) than in the Rd group (311.4 ± 11.0; P < 0.05), indicating higher satisfactory rate in the IMF group than in the Rd group. Surgeon-reported scores for breast symmetry, contour, and scar appearance were also higher in the IMF group (P < 0.05). CONCLUSIONS Immediate breast reconstruction with implant with dual-coverage fascial flap after NSM with IMF incision was associated with a lower rate of postoperative skin flap necrosis and improved patient satisfaction, compared with Rd incision. Inframammary fold incisions were associated with improved scar and breast appearance.
Collapse
|
28
|
Metere A, Fabiani E, Lonardo MT, Giannotti D, Pace D, Giacomelli L. Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications. MEDICINA-LITHUANIA 2020; 56:medicina56040166. [PMID: 32276470 PMCID: PMC7230840 DOI: 10.3390/medicina56040166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002–2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple–areola complex necrosis and infection were collected. Results: The complications detected were considered as “early” within 1 month later the nipple-sparing mastectomy or “late” after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.
Collapse
Affiliation(s)
- Alessio Metere
- Surgical Sciences Department, “Sapienza” University of Rome, Viale Regina Elena 261, 00161 Rome, Italy;
- Correspondence:
| | - Elisabetta Fabiani
- Emergency Department, Aurelia Hospital, Via Aurelia, 860, 00165 Rome, Italy;
| | - Maria Teresa Lonardo
- Department of Surgery, Ospedali Riuniti di Anzio-Nettuno, Via Cupa dei Marmi, 00042 Anzio, Italy;
| | - Domenico Giannotti
- Department of Surgery, Ospedale Belcolle, Strada Sammartinese snc, 01100 Viterbo, Italy;
| | - Daniela Pace
- Valmontone Hospital, Via dei Lecci snc, 00038 Valmontone, Italy;
| | - Laura Giacomelli
- Surgical Sciences Department, “Sapienza” University of Rome, Viale Regina Elena 261, 00161 Rome, Italy;
| |
Collapse
|
29
|
Nipple-sparing Mastectomy and Ptosis: Using a Free Nipple Graft with Tissue Expander Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2623. [PMID: 32309076 PMCID: PMC7159945 DOI: 10.1097/gox.0000000000002623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
Background: Nipple-sparing mastectomies are increasingly offered to women with breast cancer given the evidence for oncologic safety and improved cosmetic outcomes. Women with significant ptosis are often excluded due to potential nipple malposition and increased risk of nipple ischemia. The use of a harvested free nipple graft may allow women with ptosis to conserve their nipple -areolar complex. Methods: This is an IRB approved retrospective study of breast cancer patients at an academic center with ptosis who underwent free-nipple graft mastectomies with a single plastic surgeon and 5 dedicated breast surgeons from 2014-2017. The primary outcomes were free nipple graft viability and the need for revision. Secondary outcomes included post-operative complications. Results: Fourteen women with ptosis underwent skin and nipple-sparing mastectomy with breast reconstruction involving use of harvested free-nipple graft. More than half of the women were diagnosed with early-stage invasive breast cancer (42% stage 1, 14% stage 2). Four women underwent mastectomy for prophylaxis or other benign reasons. All of the women had significant ptosis during the pre-operative evaluation (57% grade 2 ptosis, 36% grade 3 ptosis, and 7% uncategorized), with an average BMI of 30. None were active smokers. In the postoperative period, one had partial nipple necrosis in combination with skin flap necrosis and positive margin (7%). Other complications included infection (14%) and hypopigmentation (14%). All nipples lost sensation and full projection. Conclusions: This is a novel approach using a free nipple graft with a skin envelope reducing mastectomy and immediate expander-based reconstruction. This successful approach allows women with ptosis to undergo nipple-sparing mastectomy with preservation of the nipple -areolar complex.
Collapse
|
30
|
Carlson GW. The changing surgical treatment of breast cancer in the United States: The tipping point. Breast J 2019; 26:11-16. [PMID: 31865619 DOI: 10.1111/tbj.13725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022]
Abstract
The surgical management of breast cancer began to change in the middle of the last decade. The use of unilateral mastectomy decreased while the rate of contralateral prophylactic mastectomy for unilateral cancer increased sixfold from 1998 to 2011. The use of immediate breast reconstruction increased from 30% in 2005 to 45% in 2012. Four changes came together in the middle of the last decade to cause this paradigm shift in the surgical management of early breast cancer. (a) Breast MRI would be available in nearly 75% of breast imaging centers. (b) Genetic counseling would become a standard of care for patients with potential hereditary breast cancer. (c) In 2006, the FDA would approve the use of silicone-gel implants. (d) Nipple-sparing mastectomy would become a standard of care in the treatment of early breast cancer.
Collapse
Affiliation(s)
- Grant W Carlson
- Division of Plastic Surgery, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
31
|
Yuce Sari S, Guler OC, Gultekin M, Akkus Yildirim B, Onal C, Ozyigit G, Yildiz F. Radiotherapy After Skin-Sparing Mastectomy and Implant-Based Breast Reconstruction. Clin Breast Cancer 2019; 19:e611-e616. [PMID: 31255547 DOI: 10.1016/j.clbc.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/17/2019] [Accepted: 04/02/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We evaluated the cosmetic results of radiotherapy (RT) after implant-based reconstruction (IBR). PATIENTS AND METHODS We retrospectively evaluated 170 patients with 171 breast cancers treated between December 2004 and January 2016 in 2 university hospitals. RT fields were reconstructed breast (RB) only in 24 (14%), and RB and regional lymphatics in 147 (86%) breasts, respectively. All but 1 patient received a total 50 Gy with conventional fractionation. All patients received systemic chemotherapy. One hundred thirty-eight (81%) patients received hormonal therapy; 118 tamoxifen and 20 aromatase inhibitor. RESULTS Median follow-up time was 46.8 months (range, 1-163 months). The 5-year disease-free and overall survival rate was 83% and 93%, respectively. Cosmetic results were considered excellent in 111 (65%), fair in 46 (27%), and bad in 14 (8%) RB by patients. Thirty-four (20%) RB had restorative surgery; because of surgeons' preference because of implant natural life time span in 5, and contracture, fibrosis, deformation, or dislocation of the implant, or cellulitis in the remaining. Statistically significant adverse factors in univariate analysis for impaired cosmetic outcome were bolus use on the RB, lymphatic irradiation, and volume that received at least 110% of the prescribed dose being > 1%. The use of bolus material was the only prognostic factor for deterioration of the cosmetic result in multivariate analysis. CONCLUSION RT after IBR yields acceptable cosmetic results. Although only 111 (65%) of RBs were considered to have excellent cosmetic results, only a small percentage of patients needed reoperation because of bad cosmetic outcome.
Collapse
Affiliation(s)
- Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey.
| |
Collapse
|
32
|
Kracoff S, Benkler M, Allweis TM, Ben-Baruch N, Egozi D. Does nipple sparing mastectomy affect the postoperative complication rate after breast reconstruction? Comparison of postoperative complications after nipple sparing mastectomy vs skin sparing mastectomy. Breast J 2019; 25:755-756. [PMID: 31066148 DOI: 10.1111/tbj.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sharon Kracoff
- Plastic and Reconstructive Surgery Department, Kaplan Medical Center, Rehovot, Israel
| | - Michal Benkler
- Plastic and Reconstructive Surgery Department, Kaplan Medical Center, Rehovot, Israel
| | - Tanir M Allweis
- General Surgery Department, Kaplan Medical Center, Rehovot, Israel.,The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Noa Ben-Baruch
- Oncology Department, Kaplan Medical Center, Rehovot, Israel
| | - Dana Egozi
- Plastic and Reconstructive Surgery Department, Kaplan Medical Center, Rehovot, Israel.,The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| |
Collapse
|
33
|
Agha RA, Al Omran Y, Wellstead G, Sagoo H, Barai I, Rajmohan S, Borrelli MR, Vella-Baldacchino M, Orgill DP, Rusby JE. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open 2018; 3:135-145. [PMID: 30957059 PMCID: PMC6433323 DOI: 10.1002/bjs5.50119] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Background The use of nipple‐sparing mastectomy (NSM) is increasing, despite unproven oncological safety in the therapeutic setting. The aim of this systematic review was to determine the safety and efficacy of NSM compared with skin‐sparing mastectomy (SSM). Methods A literature search of all original studies including RCTs, cohort studies and case–control studies comparing women undergoing therapeutic NSM or SSM for breast cancer was undertaken. Primary outcomes were oncological outcomes; secondary outcomes were clinical, aesthetic, patient‐reported and quality‐of‐life outcomes. Data analysis was undertaken to explore the relationship between NSM and SSM, and preselected outcomes. Heterogeneity was assessed using the Cochrane tests. Results A total of 690 articles were identified, of which 14 were included. There was no statistically significant difference in 5‐year disease‐free survival and mortality for NSM and SSM groups, where data were available. Local recurrence rates were also similar for NSM and SSM (3·9 versus 3·3 per cent respectively; P = 0·45). NSM had a partial or complete nipple necrosis rate of 15·0 per cent, and a higher complication rate than SSM (22·6 versus 14·0 per cent respectively). The higher overall complication rate was due to the rate of nipple necrosis in the NSM group (15·0 per cent). Conclusion In carefully selected cases, NSM is a viable choice for women with breast cancer who need to have a mastectomy. More research is needed to help further refine which surgical approaches to NSM optimize outcomes.
Collapse
Affiliation(s)
- R A Agha
- Department of Plastic Surgery, Royal Free NHS Foundation Trust London UK
| | - Y Al Omran
- Department of Plastic Surgery University Hospitals of North Midlands Stoke-on-Trent UK
| | - G Wellstead
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - H Sagoo
- GKT School of Medical Education, King's College London London UK
| | - I Barai
- Imperial College School of Medicine London UK
| | - S Rajmohan
- Imperial College School of Medicine London UK
| | - M R Borrelli
- Division of Plastic Surgery, Stanford University Stanford California USA
| | - M Vella-Baldacchino
- Department of Orthopaedics, Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - D P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital Boston Massachusetts USA
| | - J E Rusby
- Breast Surgical Unit, The Royal Marsden NHS Foundation Trust Sutton UK
| |
Collapse
|
34
|
Nipple-Sparing Mastectomy Incisions for Cancer Extirpation Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes. Plast Reconstr Surg 2018; 142:13-26. [PMID: 29878989 DOI: 10.1097/prs.0000000000004498] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy offers several advantages for women seeking postmastectomy breast reconstruction, but compromised skin and nipple perfusion may lead to skin and nipple necrosis. It is unclear whether the incisional approach contributes to these complications; therefore, the purpose of this study was to compare the impact of incision type on outcomes in patients undergoing nipple-sparing mastectomy. METHODS This is a prospective cohort study of patients undergoing nipple-sparing mastectomy with prosthetic breast reconstruction through an inframammary fold versus a lateral radial incision. Skin and nipple perfusion as represented by fluorescence intensity, mammometric parameters, patient-reported outcomes, and clinical outcomes were analyzed and compared for the two cohorts, and multivariable logistic regression models were performed to evaluate the effects of covariates on outcomes. RESULTS Seventy-nine patients were studied: 55 in the inframammary fold cohort and 24 in the lateral radial cohort. The inframammary fold group had significantly less fluorescence intensity to the inferior (21.9 percent versus 36.9 percent; p = 0.001) and lateral portions of breast skin (23.1 percent versus 40.7 percent; p = 0.003) after reconstruction. Decreased fluorescence intensity was associated with smoking, decreased mean arterial pressure, and greater specimen weight. Postreconstruction breast volumes were increased over preoperative volumes in the inframammary fold group (38.3 percent) versus the lateral radial (31.2 percent) group; however, patients with a lateral radial incision had a greater increase in satisfaction with their breasts and psychosocial well-being. CONCLUSIONS There are significant differences in patient-reported outcomes and final breast volumes based on the incisional approach to nipple-sparing mastectomy. These data can be used to guide providers and counsel patients considering nipple-sparing mastectomy with prosthetic reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
Collapse
|
35
|
Cavalcante FP, Lima MVA. Nipple-sparing mastectomy with periareolar incision and two-stage reconstruction: Initial analysis of 31 cases. Breast J 2018; 24:940-943. [PMID: 30216598 DOI: 10.1111/tbj.13114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Surgical treatment of breast cancer has changed considerably over the past four decades, culminating in the substitution of conservative approaches for Halsted's paradigm from 1894. In parallel, many breast reconstruction techniques have been proposed for patients requiring mastectomy with loss of the nipple-areola complex (NAC). Myocutaneous flaps were once the most common form of reconstruction, but recently the use of implants and nipple-sparing mastectomy (NSM) in one or two stages has gained popularity. In this descriptive and cross-sectional study, we evaluated a sample of 31 NSM procedures with periareolar incision and two-stage reconstruction (tissue expander followed by implant) conducted between 2013 and 2017, with emphasis on the rate of complications after at least 3 months of follow-up, local disease control and cosmesis measured on the Harvard scale. Five complications (16%) were observed, all of which related to the first stage: seroma (n = 1; 3.2%), treated with needle aspiration, NAC necrosis (n = 3; 9.6%), one case of which required debridement, and dehiscence (n = 1; 3.2%), treated with resuture. Cosmesis was classified as excellent by the surgeon in 96.8% (n = 27). At the time of writing, no local recurrence had been observed. In conclusion, NSM with periareolar incision and two-stage reconstruction was found to be technically feasible and associated with few complications and satisfactory esthetic outcomes.
Collapse
Affiliation(s)
- Francisco Pimentel Cavalcante
- Residency in Mastology, Ceará Cancer Institute (ICC), General Hospital of Fortaleza (HGF), Commission of Examination of Specialists in Mastology (TEMA), Fortaleza, Ceará, Brazil
| | - Marcos Venício Alves Lima
- Mastologist of Ceará Cancer Institute (ICC), Professor of Medical School of Ceará State University (UECE), Fortaleza, Ceará, Brazil
| |
Collapse
|
36
|
Clinical value of delayed 18F-FDG PET/CT for predicting nipple-areolar complex involvement in breast cancer: A comparison with clinical symptoms and breast MRI. PLoS One 2018; 13:e0203649. [PMID: 30208098 PMCID: PMC6135503 DOI: 10.1371/journal.pone.0203649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/24/2018] [Indexed: 12/19/2022] Open
Abstract
Objective We aimed to evaluate the predictive value of delayed 18F-FDG PET/CT for identifying malignancies involved in the nipple-areolar complex (NAC) in comparison with clinical symptoms and breast MRI. Methods We enrolled 90 patients who underwent preoperative delayed 18F-FDG PET/CT and MRI between October 2015 and May 2017. We calculated the NAC-Standardized uptake value ratio (SUVR) using the following formula: maximum SUV (SUVmax) of the NAC in the malignant breast /SUVmax of the NAC in the contralateral normal breast on early (NAC-SUVRearly) and delayed (NAC-SUVRdelay) phase images. MRI was used to measure the distance between the tumor and NAC and to analyze NAC enhancement patterns. Univariate and multivariate analyses were performed to identify significant predictive factors for NAC involvement. Results Seventeen patients were confirmed to have pathologic NAC involvement. NAC symptoms (p = 0.009), tumor multiplicity (p = 0.006), NAC-SUVRdelay (> 1.23, p = 0.007), and MRI-based tumor-to-NAC distance (≤ 22.0 mm, p = 0.003) were independent predictive factors for NAC involvement. Ten of 76 patients with no clinical NAC symptoms had NAC malignancy. Tumor multiplicity (p = 0.009), tumor-to-NAC distance (≤ 20.0 mm, p = 0.014)), and NAC-SUVRdelay (> 1.23, p = 0.018) had independent predictive value for NAC involvement. Conclusions Delayed 18F-FDG PET/CT is a useful modality for predicting NAC involvement in breast cancer patients whether or not NAC symptoms are present.
Collapse
|
37
|
|
38
|
Augustine P, Ramesh SA, Nair RK, Sukumaran R, Jose R, Cherian K, Muralee M, Ahamad I. Nipple Areola Complex Involvement in Invasive Carcinoma Breast. Indian J Surg Oncol 2018; 9:343-348. [PMID: 30287995 PMCID: PMC6154357 DOI: 10.1007/s13193-018-0729-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022] Open
Abstract
A variety of factors including tumor biology and distance of the tumor from the nipple have been associated with nipple areola complex involvement in patients with breast cancer. Preoperative understanding regarding these factors can help in modifying the surgical options including preservation of nipple areola complex (NAC) and breast conservation. Nipple sparing surgery (breast conservation surgery/skin sparing mastectomy with immediate reconstruction) for breast cancer has gained widespread interest with the aim of achieving oncologically safe and cosmetically acceptable outcome. To study the proportion of cases with nipple areola complex involvement in invasive carcinoma breast and to describe the variables predictive of nipple areola complex involvement in patients undergoing excision of tumor along with NAC for invasive carcinoma breast. A cross-sectional study was conducted among 136 patients who underwent mastectomy in Regional Cancer Center, Thiruvananthapuram. Tumor nipple distance was assessed preoperatively using mammogram and postoperatively by histopathological examination. Nipple involvement was seen only among 4.4%. Preoperative assessment of tumor to nipple distance, tumor size, location, and stage of the disease agrees with the histopathological examination. Only a small proportion of breast cancer has NAC involvement and preoperative assessment could help the surgeon in deciding on the feasibility of NAC preservation.
Collapse
Affiliation(s)
- Paul Augustine
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| | - Soundrarajan Alagu Ramesh
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
- Vadamalayan Hospitals, Madurai, India
| | - Ramachandran Krishnankutty Nair
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| | - Renu Sukumaran
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| | - Regi Jose
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
- Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, India
| | - Kurian Cherian
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| | - Madhu Muralee
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| | - Iqbal Ahamad
- Division of Surgical Oncology, Division of Radio Diagnosis & Division of Pathology, Regional Cancer Centre Trivandrum, Thiruvananthapuram, India
| |
Collapse
|
39
|
Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol 2018; 44:1170-1176. [DOI: 10.1016/j.ejso.2018.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
|
40
|
Ashikari AY, Kelemen PR, Tastan B, Salzberg CA, Ashikari RH. Nipple sparing mastectomy techniques: a literature review and an inframammary technique. Gland Surg 2018; 7:273-287. [PMID: 29998077 DOI: 10.21037/gs.2017.09.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nipple sparing mastectomy (NSM) has quickly become an accepted technique for patients with selected cancers and for risk reducing surgery. Much of its surgical acceptance over the last decade has been based on the low risk of nipple areolar complex (NAC) occurrence in breast cancer patients. Improved patient satisfaction due to improved cosmetic outcomes with reconstruction have also driven its popularity. We reviewed current English journals to determine the NSM techniques which achieve the lowest complications, best outcomes, and best patient satisfaction. We researched studies showing reductions in complications with improved surgical techniques and patient selection which have been implicated in improved results. In the studies reviewed, incision placement, away from the nipple, resulted in the lowest rates of ischemic nipple complications and the best cosmetic outcomes. The effect of other factors such as surgeon experience and thickness of skin flap development were more difficult to prove. Leaving a 2-3 mm rim of tissue around the nipple bundle was shown to help preserve the nipple vascularity. Lower complication rates with improved outcomes and patient satisfaction were reported in the literature in patients with B or smaller cup sizes, non-smokers, and patients with lower body mass index (BMI). Incision placement, away from the nipple, with preservation of a 2-3 mm rim of tissue around the nipple bundle along with careful patient selection were the most significant variables reviewed which helped to lower complications rates of NSM. Coordinated surgical planning with the breast and plastic surgeons to determine the best surgical approach for each individual patient is necessary to obtain the best results. Although short-term oncologic follow-up seems to be acceptable, longer follow-up will still be needed to define the best breast cancer surgical candidates for the nipple sparing approach.
Collapse
Affiliation(s)
- Andrew Y Ashikari
- Ashikari Breast Center, St. John's Riverside Health System, Yonkers, NY, USA.,NYP/Hudson Valley Hospital, Cortlandt Manor, NY, USA.,Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Pond R Kelemen
- Ashikari Breast Center, St. John's Riverside Health System, Yonkers, NY, USA.,NYP/Hudson Valley Hospital, Cortlandt Manor, NY, USA.,Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Bahar Tastan
- Ashikari Breast Center, St. John's Riverside Health System, Yonkers, NY, USA.,NYP/Hudson Valley Hospital, Cortlandt Manor, NY, USA
| | - C Andrew Salzberg
- Department of Plastic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Roy H Ashikari
- Ashikari Breast Center, St. John's Riverside Health System, Yonkers, NY, USA.,NYP/Hudson Valley Hospital, Cortlandt Manor, NY, USA.,Department of Surgery, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
41
|
Abstract
The introduction of more targeted systemic therapies, better screening modalities with earlier diagnosis and dramatically improved reconstructive techniques has allowed more minimally invasive approaches to breast surgery. The recent introduction of nipple sparing mastectomy (NSM) has dramatically improved the cosmetic outcomes and quality of life (QoL) for patients undergoing mastectomy. This technique involves preservation of both the skin envelope including the nipple areolar complex commonly through a barely visible inframammary skin incision followed by immediate breast reconstruction. An ideal candidate includes women with small breasts, absence of ptosis, low BMI and not actively smoking. High risk patients include those with radiation treatment, active smokers, macromastia, high BMI >30 kg/m2, grade 2 or 3 ptosis and active smokers. There are several new techniques to approach complex high risk patients which have expanded the candidates for NSM.
Collapse
Affiliation(s)
- Eleni Tousimis
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Michelle Haslinger
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
42
|
Jadeja P, Ha R, Rohde C, Ascherman J, Grant R, Chin C, Connolly E, Kalinsky K, Feldman S, Taback B. Expanding the Criteria for Nipple-Sparing Mastectomy in Patients With Poor Prognostic Features. Clin Breast Cancer 2018; 18:229-233. [DOI: 10.1016/j.clbc.2017.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
|
43
|
Abstract
The radical mastectomy was the mainstay of breast cancer treatment through the majority of the twentieth century. However, as the understanding of breast cancer increased, the indications for more extensive surgical intervention decreased. The mastectomy has evolved so that skin-sparing or nipple-sparing mastectomy can be performed in the majority of women who undergo mastectomy currently. Today, nearly 40% of all women undergo mastectomy for breast cancer. The improved cosmetic appearance associated with skin- or nipple-sparing mastectomies does not compromise oncologic outcomes.
Collapse
Affiliation(s)
- Caroline Jones
- Department of Surgery, University of Alabama Birmingham, 1922 7th Avenue South KB 217, Birmingham, AL 35294, USA
| | - Rachael Lancaster
- Department of Surgery, Division of Surgical Oncology, University of Alabama Birmingham, 510 20th Street South FOT 1153, Birmingham, AL 35233, USA.
| |
Collapse
|
44
|
Dorfman RG, Mioton L, Stone E, Yan W, Qiu C, Marla S, Kim JY. The Effect of Implant Type on Nipple Position Geometry and Aesthetics Following Tissue Expander Reconstruction After Nipple Sparing Mastectomy. Aesthet Surg J 2018; 38:605-613. [PMID: 29267860 DOI: 10.1093/asj/sjx210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND While recent studies have reported modest to no difference in breast aesthetics for shaped and round implant types in breast augmentations, the anatomy and biomechanics in the setting of breast reconstruction is different. OBJECTIVES Accordingly, we endeavored to evaluate whether two implant types impacted nipple position and aesthetic features in prosthetic breast reconstruction. METHODS A retrospective chart review was carried out on patients who underwent nipple-sparing mastectomy (NSM) with immediate tissue expander breast reconstruction. Patients were divided into two cohorts: smooth round implants and textured shaped implants. Postoperative photographs were evaluated to assess nipple displacement vis-à-vis a vector of maximal projection and aesthetic outcome for features of breast shape. RESULTS Of 102 breasts meeting the inclusion criteria, 41 had tissue expander-implant reconstruction with anatomical shaped implants, and 61 had reconstruction with smooth round implants. The shaped implant cohort had less nipple deviation from the point of maximal projection (3.69 ± 6.24 vs 7.52 ± 10.50; P < 0.0001). Graded semi-quantitative aesthetic scores were also higher (4.04 ± 0.67 vs 3.72 ± 0.93; P = 0.0044) in the shaped implants than in the round cohort. CONCLUSIONS Unlike breast augmentation, there is a paucity of overlying breast tissue and larger dissected spaces in prosthetic breast reconstruction. Our analysis suggests that in this setting, textured anatomic implants result in less nipple deviation from the point of maximum projection and improved aesthetic outcomes compared to round implants. When considering implant choice in NSM reconstruction, the manifold risks of shaped textured implants must thus be informed by potential aesthetic benefits with respect to shape and enhanced nipple sensation. LEVEL OF EVIDENCE 4
Collapse
Affiliation(s)
- Robert G Dorfman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Mioton
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Stone
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wenhui Yan
- Department of Breast Surgery, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Cecil Qiu
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sekhar Marla
- Department of Surgery, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - John Y Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
45
|
La Padula S, Billon R, Schonauer F, D'Andrea F, Noel W, Belkacémi Y, Bosc R, Hersant B, Meningaud JP. Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery. ANN CHIR PLAST ESTH 2018; 63:285-293. [PMID: 29566954 DOI: 10.1016/j.anplas.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 02/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Breast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery. METHODS A systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016. RESULTS Among the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated. CONCLUSIONS Breast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used.
Collapse
Affiliation(s)
- S La Padula
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - R Billon
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - F Schonauer
- Department of plastic, reconstructive and aesthetic surgery, university of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - F D'Andrea
- Department of plastic, reconstructive and aesthetic surgery, university of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - W Noel
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Y Belkacémi
- Radiation oncology department, GH Henri-Mondor Breast center, university Paris-East Créteil (UPEC), AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - R Bosc
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - B Hersant
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J P Meningaud
- Department of plastic, reconstructive aesthetic and maxillofacial surgery, Henri-Mondor hospital, université Paris Est Créteil (UPEC), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| |
Collapse
|
46
|
Sarfati B, Honart JF, Leymarie N, Rimareix F, Al Khashnam H, Kolb F. Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report. Breast J 2017; 24:373-376. [DOI: 10.1111/tbj.12937] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Benjamin Sarfati
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Francoise Rimareix
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Heba Al Khashnam
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Frederic Kolb
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| |
Collapse
|
47
|
Orcutt ST, O’Donoghue C, Smith P, Laronga C. Expanding Eligibility Criteria for Nipple-Sparing Mastectomy. South Med J 2017; 110:654-659. [DOI: 10.14423/smj.0000000000000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
48
|
Allain DC, Sweet K, Agnese DM. Management Options after Prophylactic Surgeries in Women with BRCA Mutations: A Review. Cancer Control 2017; 14:330-7. [PMID: 17914333 DOI: 10.1177/107327480701400403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Although breast cancer is relatively common, only about 5% of cases are due to inheritance of highly penetrant cancer susceptibility genes. The majority of these are caused by mutations in the BRCA1 and BRCA2 genes, which are also associated with an increased risk of ovarian cancer. Increased surveillance, chemoprevention, and prophylactic surgeries are standard options for the effective medical management of mutation carriers. However, optimal management of female carriers who choose to undergo prophylactic surgeries is still poorly understood. Methods The authors provide an overview of the current literature regarding medical management options for women carriers of BRCA1 and BRCA2 gene mutations and the implications for those individuals who have chosen to undergo prophylactic surgeries. Results BRCA mutation carriers who opt for prophylactic surgeries are still at risk for development of malignancy, and appropriate monitoring is warranted. Conclusions There are limited data on the appropriate medical management for BRCA mutation carriers after prophylactic surgeries. However, a management plan can be extrapolated from the general management recommendations for surveillance and other risk-reducing strategies in BRCA-positive individuals.
Collapse
Affiliation(s)
- Dawn C Allain
- Clinical Cancer and Human Cancer Genetics Programs and Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus 43210, USA
| | | | | |
Collapse
|
49
|
Knabben L, Kanagalingam G, Imboden S, Günthert AR. Acellular Dermal Matrix (Permacol ®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature. Front Med (Lausanne) 2017; 3:72. [PMID: 28105410 PMCID: PMC5213735 DOI: 10.3389/fmed.2016.00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Skin-sparing mastectomy (SSM) with immediate heterologous reconstruction is a safe oncological option in surgical therapy of early breast cancer. Permacol® is an acellular dermal matrix (ADM) placed between the implant and the skin to improve lower pole projection and implant coverage. The aim of our study was to evaluate the outcome with a focus on patient satisfaction after 6 months and to analyze physical changes of ADM. METHODS 10 patients who underwent SSM with Permacol® were analyzed retrospectively. All patients were followed using a satisfaction questionnaire and an ultrasound evaluation of the tissue thickness of the pectoralis muscle and the Permacol®. RESULTS No intraoperative complications were observed. One patient required removal of the implant for necrosis after 3 months. Half of the patients underwent secondary corrective surgery. A statistically significant thinning of the pectoralis muscle was observed, compared to the thickening of the Permacol®. A majority of the patients were satisfied with the operation, and we found a correlation between lower body mass index and patient satisfaction. CONCLUSION In our small case series Permacol®-assisted immediate reconstruction is shown to be an option for selected cases. Physical changes of Permacol® result in a symmetrical coverage of the implant, which may improve cosmetic outcome.
Collapse
Affiliation(s)
- Laura Knabben
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Gowthami Kanagalingam
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Andreas R Günthert
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne , Lucerne , Switzerland
| |
Collapse
|
50
|
Karian LS, Therattil PJ, Wey PD, Nini KT. Delay techniques for nipple-sparing mastectomy: A systematic review. J Plast Reconstr Aesthet Surg 2016; 70:236-242. [PMID: 28040452 DOI: 10.1016/j.bjps.2016.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/18/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications and may be combined with retroareolar biopsy as a first-stage procedure. We performed a systematic review of the literature to evaluate various techniques for NAC and mastectomy flap delay. METHODS PubMed and Cochrane databases were searched from January 1975 through April 15, 2016. The following search terms were used for both titles and key words: 'nipple sparing mastectomy' AND ('delay' OR 'stage' OR 'staged'). Two independent reviewers determined the study eligibility, only accepting studies involving patients who underwent a delay procedure prior to NSM and studies with objective results including specific outcomes of NAC and mastectomy flap necrosis. RESULTS The literature search yielded 242 studies, of which five studies met the inclusion criteria, with a total of 101 patients. Various techniques for NSM delay have been described, all of which involve undermining the nipple and surrounding mastectomy skin to some degree. Partial NAC necrosis was reported in a total of 9 patients (8.9%). Mastectomy flap necrosis was reported in a total of 8 patients (7.9%). Three of five studies reported positive retroareolar biopsy findings in a total of 7 patients (6.9%). CONCLUSIONS Delay procedures for NSM have a good safety profile and may be considered in patients at risk for NAC or mastectomy flap necrosis, such as patients with pre-existing breast scars, active smoking, prior radiation, or ptosis. These procedures have the added benefit of allowing a retroareolar biopsy to be sent for permanent sections prior to mastectomy, allowing the surgical team to plan for the removal of the NAC at the time of mastectomy if indicated and eliminating the risk of a false-negative result on frozen section analysis.
Collapse
Affiliation(s)
- Laurel S Karian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Paul J Therattil
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Philip D Wey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kevin T Nini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|