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Breast Cancer

, Volume 24, Issue 3, pp 451–457 | Cite as

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

  • Donato Casella
  • Claudio Calabrese
  • Lorenzo Orzalesi
  • Ilaria Gaggelli
  • Lorenzo Cecconi
  • Caterina Santi
  • Roberto Murgo
  • Stefano Rinaldi
  • Lea Regolo
  • Claudio Amanti
  • Manuela Roncella
  • Margherita Serra
  • Graziano Meneghini
  • Massimiliano Bortolini
  • Vittorio Altomare
  • Carlo Cabula
  • Francesca Catalano
  • Alfredo Cirilli
  • Francesco Caruso
  • Maria Grazia Lazzaretti
  • Icro Meattini
  • Lorenzo Livi
  • Luigi Cataliotti
  • Marco Bernini
Original Article

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.

Keywords

Nipple-sparing mastectomy Breast reconstruction Tissue expander Direct-to-implant Autologous breast reconstruction 

Notes

Compliance with ethical standards

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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Copyright information

© The Japanese Breast Cancer Society 2016

Authors and Affiliations

  • Donato Casella
    • 1
  • Claudio Calabrese
    • 1
  • Lorenzo Orzalesi
    • 1
  • Ilaria Gaggelli
    • 1
  • Lorenzo Cecconi
    • 2
  • Caterina Santi
    • 1
  • Roberto Murgo
    • 3
  • Stefano Rinaldi
    • 4
  • Lea Regolo
    • 5
  • Claudio Amanti
    • 6
  • Manuela Roncella
    • 7
  • Margherita Serra
    • 8
  • Graziano Meneghini
    • 9
  • Massimiliano Bortolini
    • 10
  • Vittorio Altomare
    • 11
  • Carlo Cabula
    • 12
  • Francesca Catalano
    • 13
  • Alfredo Cirilli
    • 14
  • Francesco Caruso
    • 15
  • Maria Grazia Lazzaretti
    • 16
  • Icro Meattini
    • 17
  • Lorenzo Livi
    • 17
  • Luigi Cataliotti
    • 18
  • Marco Bernini
    • 1
  1. 1.Oncologic and Reconstructive Surgery, Breast Unit SurgeryCareggi University HospitalFlorenceItaly
  2. 2.Statistics, Department of Statistics, Informatics and Application “G.Parenti”University of FlorenceFlorenceItaly
  3. 3.Breast Unit SurgerySan Giovanni Rotondo HospitalS.Giovanni RotondoItaly
  4. 4.Breast Unit SurgerySan Paolo HospitalBariItaly
  5. 5.Breast Unit SurgeryMaugeri HospitalPaviaItaly
  6. 6.Breast Unit SurgerySant’Andrea HospitalRomeItaly
  7. 7.Breast Unit SurgeryCisanello HospitalPisaItaly
  8. 8.Breast Unit SurgerySant’Orsola HospitalBolognaItaly
  9. 9.Breast UnitMontecchio Maggiore HospitalMontecchio MaggioreItaly
  10. 10.Breast Unit SurgeryValdese HospitalTurinItaly
  11. 11.Breast UnitCampus Biomedico HospitalRomeItaly
  12. 12.Breast Unit SurgeryBusinco HospitalCagliariItaly
  13. 13.Breast UnitCannizzaro HospitalCataniaItaly
  14. 14.Breast Unit SurgeryPoliclinico HospitalBariItaly
  15. 15.Breast Unit SurgeryHumanitas HospitalCataniaItaly
  16. 16.Breast Unit SurgeryRamazzini HospitalCarpi (Modena)Italy
  17. 17.Radiation-Oncology, Oncology DepartmentCareggi University HospitalFlorenceItaly
  18. 18.President European Breast Centres Certification, President Senonetwork Italia OnlusFlorenceItaly

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