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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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.
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.
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.
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.
KeywordsNipple-sparing mastectomy Breast reconstruction Tissue expander Direct-to-implant Autologous breast reconstruction
Compliance with ethical standards
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.
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.
- 11.American Society of Plastic Surgeons Statistics. http://www.plasticsurgery.org/Documents/news-resources/statistics. Accessed 4 Feb 2016.