Direct-to-implant Breast Reconstruction Following Nipple-sparing Mastectomy: Predictive Factors of Adverse Surgical Outcomes in Asian Patients

Overview

Journal Arch Plast Surg

Specialty General Surgery

Date 2021 Sep 28

PMID 34583432

Citations 3

Authors

Chun-Lin Su

Jia-Ruei Yang

Wen-Ling Kuo

Shin-Cheh Chen

David Chon-Fok Cheong

Jung-Ju Huang

Affiliations

Soon will be listed here.

Abstract

Background: Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.

Methods: Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.

Results: There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50-19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08-2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07-15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25-24.93; P=0.025).

Conclusions: Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.

Citing Articles

Long-Term Follow-Up of Surgical Outcomes and Oncological Results of Nipple-Sparing Mastectomy with Immediate Reconstruction Through a Single Axillary Incision with Different Approach Methods.

Gau R, Chou H, Tsai H, Shen S, Kuo W, Chu C Ann Surg Oncol. 2024; 32(3):2092-2102.

PMID: 39710805 DOI: 10.1245/s10434-024-16672-0.

Comparison of Effects of Acellular Dermal Matrix and Latissimus Dorsi Muscle Flap on Radiation-induced Peri-implant Capsular Contracture in a Rabbit Model.

Jang S, Ahn I, Bae T, Kang S, Woo S, Kim W Arch Plast Surg. 2024; 51(6):581-591.

PMID: 39544515 PMC: 11560322. DOI: 10.1055/a-2368-1813.

Radiotherapy dosimetry and radiotherapy related complications of immediate implant-based reconstruction after breast cancer surgery.

Zhang Y, Ye F, Teng Y, Zheng J, Li C, Ma R Front Oncol. 2023; 13:1207896.

PMID: 37886175 PMC: 10598640. DOI: 10.3389/fonc.2023.1207896.

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