Evaluating Long-Term Outcomes following Nipple-Sparing Mastectomy and Reconstruction in the Irradiated Breast

Comparing Nipple-sparing Mastectomy to Secondary Nipple Reconstruction: A Multi-institutional Study

OBJECTIVE

The primary aim of this study was to compare patient-reported outcomes (PROs) of women who underwent immediate implant-based breast reconstruction (IBBR) after receiving either: (1) nipple-sparing mastectomy (NSM) or (2) simple mastectomy with subsequent nipple reconstruction (SNR).

BACKGROUND

The goal of post-mastectomy breast reconstruction is to restore body image and quality-of-life after mastectomy, but removal of the nipple-areolar complex may have its own negative psychosocial consequences. NSM may have increased in popularity due to its perceived oncologic safety in many women and to reports of superior aesthetic results with this technique. Despite the increased utilization of NSM, few studies have evaluated the impact of NSM on PROs and complications in women undergoing immediate IBBR.

METHODS

We performed a secondary analysis of the Mastectomy Reconstruction Outcomes Consortium study, a multicenter, prospective cohort study that recruited patients between February 2012 and July 2015. The primary aim of this study was to compare PROs as measured by BREAST-Q scores between women who underwent IBBR after NSM versus SNR. The secondary aim was to compare complication rates. Mixed-effects regression models controlled for demographic and clinical covariates.

RESULTS

Of the 600 women in the study, 286 (47.7%) underwent NSM. After controlling for baseline patient characteristics, we found no significant differences in satisfaction with breast, psychosocial well-being, physical well-being or sexual well-being between women undergoing NSM versus SNR. Mastectomy type was not a significant predictor of complications or reconstructive failure.

CONCLUSIONS

Despite reports of superior aesthetics for NSM over simple mastectomy with nipple reconstruction in immediate IBBR, we found no significant differences at 2 years after reconstruction in patient satisfaction, quality-of-life, or complication rates.

Expander implantation for correction of high-riding nipple with enlarged nipple-areola complex using revision mastopexy: A case report

BACKGROUND

High-riding nipple is one of the common complications after mastopexty and breast reconstruction. However, to date, a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.

CASE SUMMARY

This is a case report describing a combination of surgical techniques to decrease high-riding nipple. A 26-year-old woman, who previously underwent several breast operations, sought correction for high-riding nipple with enlarged areola. Expanders were used and multi-stage techniques were performed. After one year of follow-up, lowered nipple, reduced areola size, ensured nipple blood supply, and improved breast ptosis were achieved, and the patient was satisfied with the breast contour.

CONCLUSION

The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.