Advertisement

Annals of Surgical Oncology

, Volume 22, Issue 10, pp 3331–3337 | Cite as

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

  • Rong Tang
  • Suzanne B. Coopey
  • Amy S. Colwell
  • Michelle C. Specht
  • Michele A. Gadd
  • Kari Kansal
  • Maureen P. McEvoy
  • Andrea L. Merrill
  • Upahvan Rai
  • Alphonse Taghian
  • William G. Austen
  • Barbara L. Smith
Breast Oncology

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.

Keywords

Breast Reconstruction Nipple Surgical Revision Capsular Contracture Breast Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The authors declare no conflict of interest.

References

  1. 1.
    Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124:1772–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Babiera G, Simmons R. Nipple–areolar complex–sparing mastectomy: feasibility, patient selection, and technique. Ann Surg Oncol. 2010;17(suppl 3):245–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Djohan R, Gage E, Gatherwright J, et al. Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study. Plast Reconstr Surg. 2010;125:818–29.CrossRefPubMedGoogle Scholar
  4. 4.
    Spear SL, Willey SC, Feldman ED, et al. Nipple-sparing mastectomy for prophylactic and therapeutic indications. Plast Reconstr Surg. 2011;128:1005–14.CrossRefPubMedGoogle Scholar
  5. 5.
    Eriksson M, Anveden L, Celebioglu F, et al. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat. 2013;142:591–601.CrossRefPubMedGoogle Scholar
  6. 6.
    Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg. 2006;117:359–65.CrossRefPubMedGoogle Scholar
  7. 7.
    Spear SL, Shuck J, Hannan L, Albino F, Patel KM. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg. 2014;133:605–14.CrossRefGoogle Scholar
  8. 8.
    Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Colwell AS, Tessler O, Lin AM, et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg. 2014;133:496–506.CrossRefPubMedGoogle Scholar
  10. 10.
    Evans GR, Schusterman MA, Kroll SS, et al. Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg. 1995;96:1111–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Forman DL, Chiu J, Restifo RJ, Ward BA, Haffty B, Ariyan S. Breast reconstruction in previously irradiated patients using tissue expanders and implants: a potentially unfavorable result. Ann Plast Surg. 1998;40:360–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Vandeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg. 2000;106:56–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Cordeiro PG, McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg. 2006;118:825–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Cordeiro PG, Snell L, Heerdt A, McCarthy C. Immediate tissue expander/implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy/irradiation. Plast Reconstr Surg. 2012;129:341–50.CrossRefPubMedGoogle Scholar
  15. 15.
    Peled AW, Foster RD, Stover AC, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012;19:3402–9.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Rong Tang
    • 1
    • 2
  • Suzanne B. Coopey
    • 1
  • Amy S. Colwell
    • 3
  • Michelle C. Specht
    • 1
  • Michele A. Gadd
    • 1
  • Kari Kansal
    • 1
  • Maureen P. McEvoy
    • 1
  • Andrea L. Merrill
    • 1
  • Upahvan Rai
    • 1
  • Alphonse Taghian
    • 4
  • William G. Austen
    • 3
  • Barbara L. Smith
    • 1
  1. 1.Division of Surgical Oncology, Gillette Center for Women’s CancersMassachusetts General HospitalBostonUSA
  2. 2.Division of Breast Surgery, Hunan Cancer HospitalThe Affiliated Tumor Hospital of Xiangya Medical School of Central South UniversityChangshaChina
  3. 3.Division of Plastic SurgeryMassachusetts General HospitalBostonUSA
  4. 4.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

Personalised recommendations