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Nipple-Sparing Mastectomy in Irradiated Breasts: Selecting Patients to Minimize Complications

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nipple-sparing mastectomies (NSM) are increasingly common because of their cosmetic advantage. Radiotherapy (RT) has been a relative contraindication to immediate reconstruction because of concerns about increased complications. We aimed to evaluate outcomes of NSM plus immediate reconstruction in irradiated breasts and to determine additional risk factors for complications.

Methods

We retrospectively reviewed NSM with immediate reconstruction from 2007 to 2013 at our institution. Complications were broken down into several categories. Potential risk factors for complications were evaluated.

Results

There were 982 NSM: 816 had no RT, 67 had prior RT, and 97 had postmastectomy radiotherapy (PMRT). Compared to breasts with no RT, both prior RT and PMRT increased overall complications (10.2 vs. 21.7 and 17.5 %, p = 0.003, 0.03, respectively) and nipple loss (0.9 vs. 4.3 and 4.1 %, p = 0.04, 0.02, respectively), while PMRT increased rate of reconstruction failure (2.2 vs. 8.2 %, p = 0.003). On multivariate regression analysis, prior RT [odds ratio (OR) 2.53, p = 0.006], PMRT (OR 2.29, p = 0.015), age >55 years (OR 2.03, p = 0.04), breast volume ≥800 cm3 (OR 1.96, p = 0.04), smoking (OR 2.62, p = 0.001), and periareolar incision (OR 1.74, p = 0.03) were independent risk factors for complications requiring surgical revision. In irradiated breasts, complication rates were 13.4 % without further risk factors and 17.5, 50, and 66.7 % when 1, 2, and ≥3 additional independent risk factors were present, respectively (p < 0.001).

Conclusions

Although complication rates were higher in irradiated breasts, reconstruction failure and nipple/areola necrosis was infrequent. RT should not be a contraindication to NSM. Preoperative identification of risk factors and appropriate patient selection may reduce complication rates.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, Gillette Center for Women’s Cancers, Massachusetts General Hospital, Boston, MA, USA

    Rong Tang MD, Suzanne B. Coopey MD, Michelle C. Specht MD, Michele A. Gadd MD, Kari Kansal MD, Maureen P. McEvoy MD, Andrea L. Merrill MD, Upahvan Rai MD & Barbara L. Smith MD, PhD

  2. Division of Breast Surgery, Hunan Cancer Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China

    Rong Tang MD

  3. Division of Plastic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Amy S. Colwell MD & William G. Austen MD

  4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Alphonse Taghian MD, PhD

Authors
  1. Rong Tang MD
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  2. Suzanne B. Coopey MD
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  3. Amy S. Colwell MD
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  4. Michelle C. Specht MD
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  5. Michele A. Gadd MD
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  6. Kari Kansal MD
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  7. Maureen P. McEvoy MD
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  8. Andrea L. Merrill MD
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  9. Upahvan Rai MD
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  10. Alphonse Taghian MD, PhD
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  11. William G. Austen MD
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  12. Barbara L. Smith MD, PhD
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Corresponding author

Correspondence to Barbara L. Smith MD, PhD.

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Tang, R., Coopey, S.B., Colwell, A.S. et al. Nipple-Sparing Mastectomy in Irradiated Breasts: Selecting Patients to Minimize Complications. Ann Surg Oncol 22, 3331–3337 (2015). https://doi.org/10.1245/s10434-015-4669-y

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  • DOI: https://doi.org/10.1245/s10434-015-4669-y

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