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Breast Cancer Research and Treatment

, Volume 140, Issue 3, pp 545–555 | Cite as

Clinical outcomes following nipple–areola-sparing mastectomy with immediate implant-based breast reconstruction: a 12-year experience with an analysis of patient and breast-related factors for complications

  • Alexandre Mendonça Munhoz
  • Cláudia Maria Aldrighi
  • Eduardo Montag
  • Eduardo Gustavo Arruda
  • José Mendes Aldrighi
  • Rolf Gemperli
  • Jose Roberto Filassi
  • Marcus Castro Ferreira
Epidemiology

Abstract

Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM and differences between clinical risk factors, breast volume, and different incision types. In a cohort-designed study, 158 reconstructed patients (invasive/in situ cancer and high risk for cancer) were stratified into groups based on different types of incision used (hemi-periareolar, double-circle periareolar, and Wise-pattern). They were matched for age, body mass index, associated clinical diseases, smoking, and weight of specimen. Also included were patients treated with adjuvant chemotherapy and postoperative radiotherapy. Mean follow-up was 65.6 months. In 106 (67 %) patients, NSM was performed for breast cancer treatment and in 52 (32.9 %) for cancer prophylaxis. Thirty-nine (24.6 %) patients were submitted to hemi-periareolar technique, 67 (42.4 %) to double-circle periareolar incision, and 52 (33 %) to Wise-pattern incision. The reconstruction was performed with tissue expander and implant–expander. Local recurrence rate was 3.7 % and the incidence of distant metastases was 1.8 %. Obese patients and higher weight of specimen had a higher risk for complications. After adjusting risk factors (BMI, weight of specimen), the complications were higher for patients submitted to hemi-periareolar and Wise-pattern incisions. This follow-up survey demonstrates that NSM facilitates optimal breast reconstruction by preserving the majority of the breast skin. Selected patients can have safe outcomes and therefore this may be a feasible option for breast cancer management. Success depends on coordinated planning with the oncologic surgeon and careful preoperative and intraoperative management. Surgical risk factors include incision type, obesity, and weight of breast specimen.

Keywords

Breast reconstruction Skin-sparing mastectomy Nipple-sparing mastectomy Outcome Complications Silicone breast implants 

Abbreviations

SSM

Skin-sparing mastectomy

NSM

Nipple-sparing mastectomy

NAC

Nipple–areola complex

LDMF

Latissimus dorsi myocutaneous flap

TRAM

Transversus rectus abdominis myocutaneous flap

BMI

Body mass index

Notes

Acknowledgements

We would like to thank Angela Paes for statistical analysis, Teresa Curi for English revision and Rodrigo Tonan for the illustration.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alexandre Mendonça Munhoz
    • 1
  • Cláudia Maria Aldrighi
    • 1
  • Eduardo Montag
    • 3
  • Eduardo Gustavo Arruda
    • 3
  • José Mendes Aldrighi
    • 4
  • Rolf Gemperli
    • 5
  • Jose Roberto Filassi
    • 1
    • 2
    • 3
  • Marcus Castro Ferreira
    • 5
  1. 1.Division of Plastic SurgeryHospital Sírio-LibanêsSão PauloBrazil
  2. 2.Breast Surgery Group, Cancer Institute of São PauloUniversity of São PauloSão PauloBrazil
  3. 3.Cancer Institute of São PauloUniversity of São PauloSão PauloBrazil
  4. 4.Public Health Sciences DepartmentUniversity of São PauloSão PauloBrazil
  5. 5.Plastic Surgery DivisionUniversity of São Paulo School of MedicineSão PauloBrazil

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