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Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period

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Abstract

Background

Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study.

Methods

Data extraction from the National Database was performed restricting cases to the 2009–2014 period. Different reconstruction procedures were analyzed in terms of their distribution over time and with respect to specific indications. A 1-year minimum follow-up was conducted to assess reconstructive unsuccessful events. Univariate and multivariate analyses were performed to investigate the causes of both prosthetic and autologous failures.

Results

913 patients, for a total of 1006 procedures, are included in the analysis. A prosthetic only reconstruction is accomplished in 92.2 % of cases, while pure autologous tissues are employed in 4.2 % and a hybrid (prosthetic plus autologous) in 3.6 %. Direct-to-implant (DTI) reaches 48.7 % of all reconstructions in the year 2014. Prophylactic NSMs have a DTI reconstruction in 35.6 % of cases and an autologous tissue flap in 12.9 % of cases. Failures are 2.7 % overall: 0 % in pure autologous flaps and 9.1 % in hybrid cases. Significant risk factors for failures are diabetes and the previous radiation therapy on the operated breast.

Conclusions

Reconstruction following NSM is mostly prosthetic in Italy, with DTI gaining large acceptance over time. Failures are low and occurring in diabetic and irradiated patients at the multivariate analysis.

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Authors and Affiliations

  1. Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy

    Donato Casella, Claudio Calabrese, Lorenzo Orzalesi, Ilaria Gaggelli, Caterina Santi & Marco Bernini

  2. Statistics, Department of Statistics, Informatics and Application “G.Parenti”, University of Florence, Viale Morgagni 59, 50134, Florence, Italy

    Lorenzo Cecconi

  3. Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, 71013, S.Giovanni Rotondo, Foggia, Italy

    Roberto Murgo

  4. Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, 70123, Bari, Italy

    Stefano Rinaldi

  5. Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, 27100, Pavia, Italy

    Lea Regolo

  6. Breast Unit Surgery, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy

    Claudio Amanti

  7. Breast Unit Surgery, Cisanello Hospital, Via Roma 67, 56123, Pisa, Italy

    Manuela Roncella

  8. Breast Unit Surgery, Sant’Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy

    Margherita Serra

  9. Breast Unit, Montecchio Maggiore Hospital, Via Ca’ Rotte 7, 36075, Montecchio Maggiore, Vicenza, Italy

    Graziano Meneghini

  10. Breast Unit Surgery, Valdese Hospital, Via Pellico 19, 10125, Turin, Italy

    Massimiliano Bortolini

  11. Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy

    Vittorio Altomare

  12. Breast Unit Surgery, Businco Hospital, Via Jenner 1, 09127, Cagliari, Italy

    Carlo Cabula

  13. Breast Unit, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy

    Francesca Catalano

  14. Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy

    Alfredo Cirilli

  15. Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, 95126, Catania, Italy

    Francesco Caruso

  16. Breast Unit Surgery, Ramazzini Hospital, Via Molinari 2, 41012, Carpi (Modena), Italy

    Maria Grazia Lazzaretti

  17. Radiation-Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy

    Icro Meattini & Lorenzo Livi

  18. President European Breast Centres Certification, President Senonetwork Italia Onlus, Florence, Italy

    Luigi Cataliotti

Authors
  1. Donato Casella
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  2. Claudio Calabrese
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  3. Lorenzo Orzalesi
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  4. Ilaria Gaggelli
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  5. Lorenzo Cecconi
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  6. Caterina Santi
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  7. Roberto Murgo
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  8. Stefano Rinaldi
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  9. Lea Regolo
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  10. Claudio Amanti
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  11. Manuela Roncella
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  12. Margherita Serra
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  13. Graziano Meneghini
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  14. Massimiliano Bortolini
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  15. Vittorio Altomare
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  16. Carlo Cabula
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  17. Francesca Catalano
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  18. Alfredo Cirilli
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  19. Francesco Caruso
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  20. Maria Grazia Lazzaretti
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  21. Icro Meattini
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  22. Lorenzo Livi
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  23. Luigi Cataliotti
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  24. Marco Bernini
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Corresponding author

Correspondence to Marco Bernini.

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Funding

National Registry Website was created with the funds of “La corsa della speranza”, Montecatini Terme, Pistoia, 2010 (© 2014 Associazione Correre per la Speranza—C.F. 97493810150. All rights reserved). Institutional University of Florence funds for Scientific Research Projects covered all other expenses for this study.

Conflict of interest

All Authors disclaim any conflict of interest.

Ethical standards

The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. No institutional ethical approval was required.

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Casella, D., Calabrese, C., Orzalesi, L. et al. Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period. Breast Cancer 24, 451–457 (2017). https://doi.org/10.1007/s12282-016-0726-z

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  • DOI: https://doi.org/10.1007/s12282-016-0726-z

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