Microsurgical breast reconstruction for nipple-sparing mastectomy

Neil Tanna, P. Niclas Broer, Katie E. Weichman, Michael Alperovich, Christina Y. Ahn, Robert J. Allen, Mihye Choi, Nolan S. Karp, Pierre B. Saadeh, Jamie P. Levine

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Nipple-sparing mastectomy warrants thorough preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. To the authorsÊ knowledge, this review represents the largest series of microsurgical breast reconstructions following nipple-sparing mastectomies. METHODS: All patients undergoing nipple-sparing mastectomy with microsurgical immediate breast reconstruction treated at New York University Medical Center (2007-2011) were identified. Patient demographics, breast cancer history, intraoperative details, complications, and revision operations were examined. Descriptive statistical analysis, including t test or regression analysis, was performed. RESULTS: In 51 patients, 85 free flap breast reconstructions (n = 85) were performed. The majority of flaps were performed for prophylactic indications [n = 55 (64.7 percent)], mostly through vertical incisions [n = 40 (47.0 percent)]. Donor sites included abdominally based [n = 66 (77.6 percent)], profunda artery perforator [n = 12 (14.1 percent)], transverse upper gracilis [n = 6 (7.0 percent)], and superior gluteal artery perforator [n = 1 (1.2 percent)] flaps. The most common complications were mastectomy skin flap necrosis [n = 11 (12.7 percent)] and nipple necrosis [n = 11 (12.7 percent)]. There was no correlation between mastectomy skin flap or nipple necrosis and choice of incision, mastectomy specimen weight, body mass index, or age (p > 0.05). However, smoking history was associated with nipple necrosis (p < 0.01). CONCLUSIONS: This series represents a high-volume experience with nipple-sparing mastectomy followed by immediate microsurgical reconstruction. When appropriately executed, it can deliver low complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish (US)
JournalPlastic and Reconstructive Surgery
Volume131
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

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Nipples
Mammaplasty
Mastectomy
Necrosis
Arteries
Skin
Free Tissue Flaps
Intraoperative Complications
Risk Reduction Behavior
Patient Satisfaction
Esthetics
Body Mass Index
Smoking
History
Regression Analysis
Demography
Tissue Donors
Breast Neoplasms
Weights and Measures

ASJC Scopus subject areas

  • Surgery

Cite this

Microsurgical breast reconstruction for nipple-sparing mastectomy. / Tanna, Neil; Broer, P. Niclas; Weichman, Katie E.; Alperovich, Michael; Ahn, Christina Y.; Allen, Robert J.; Choi, Mihye; Karp, Nolan S.; Saadeh, Pierre B.; Levine, Jamie P.

In: Plastic and Reconstructive Surgery, Vol. 131, No. 2, 02.2013.

Research output: Contribution to journalArticle

Tanna, N, Broer, PN, Weichman, KE, Alperovich, M, Ahn, CY, Allen, RJ, Choi, M, Karp, NS, Saadeh, PB & Levine, JP 2013, 'Microsurgical breast reconstruction for nipple-sparing mastectomy', Plastic and Reconstructive Surgery, vol. 131, no. 2. https://doi.org/10.1097/PRS.0b013e3182789b51
Tanna, Neil ; Broer, P. Niclas ; Weichman, Katie E. ; Alperovich, Michael ; Ahn, Christina Y. ; Allen, Robert J. ; Choi, Mihye ; Karp, Nolan S. ; Saadeh, Pierre B. ; Levine, Jamie P. / Microsurgical breast reconstruction for nipple-sparing mastectomy. In: Plastic and Reconstructive Surgery. 2013 ; Vol. 131, No. 2.
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AU - Ahn, Christina Y.

AU - Allen, Robert J.

AU - Choi, Mihye

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AU - Levine, Jamie P.

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N2 - BACKGROUND: Nipple-sparing mastectomy warrants thorough preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. To the authorsÊ knowledge, this review represents the largest series of microsurgical breast reconstructions following nipple-sparing mastectomies. METHODS: All patients undergoing nipple-sparing mastectomy with microsurgical immediate breast reconstruction treated at New York University Medical Center (2007-2011) were identified. Patient demographics, breast cancer history, intraoperative details, complications, and revision operations were examined. Descriptive statistical analysis, including t test or regression analysis, was performed. RESULTS: In 51 patients, 85 free flap breast reconstructions (n = 85) were performed. The majority of flaps were performed for prophylactic indications [n = 55 (64.7 percent)], mostly through vertical incisions [n = 40 (47.0 percent)]. Donor sites included abdominally based [n = 66 (77.6 percent)], profunda artery perforator [n = 12 (14.1 percent)], transverse upper gracilis [n = 6 (7.0 percent)], and superior gluteal artery perforator [n = 1 (1.2 percent)] flaps. The most common complications were mastectomy skin flap necrosis [n = 11 (12.7 percent)] and nipple necrosis [n = 11 (12.7 percent)]. There was no correlation between mastectomy skin flap or nipple necrosis and choice of incision, mastectomy specimen weight, body mass index, or age (p > 0.05). However, smoking history was associated with nipple necrosis (p < 0.01). CONCLUSIONS: This series represents a high-volume experience with nipple-sparing mastectomy followed by immediate microsurgical reconstruction. When appropriately executed, it can deliver low complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

AB - BACKGROUND: Nipple-sparing mastectomy warrants thorough preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. To the authorsÊ knowledge, this review represents the largest series of microsurgical breast reconstructions following nipple-sparing mastectomies. METHODS: All patients undergoing nipple-sparing mastectomy with microsurgical immediate breast reconstruction treated at New York University Medical Center (2007-2011) were identified. Patient demographics, breast cancer history, intraoperative details, complications, and revision operations were examined. Descriptive statistical analysis, including t test or regression analysis, was performed. RESULTS: In 51 patients, 85 free flap breast reconstructions (n = 85) were performed. The majority of flaps were performed for prophylactic indications [n = 55 (64.7 percent)], mostly through vertical incisions [n = 40 (47.0 percent)]. Donor sites included abdominally based [n = 66 (77.6 percent)], profunda artery perforator [n = 12 (14.1 percent)], transverse upper gracilis [n = 6 (7.0 percent)], and superior gluteal artery perforator [n = 1 (1.2 percent)] flaps. The most common complications were mastectomy skin flap necrosis [n = 11 (12.7 percent)] and nipple necrosis [n = 11 (12.7 percent)]. There was no correlation between mastectomy skin flap or nipple necrosis and choice of incision, mastectomy specimen weight, body mass index, or age (p > 0.05). However, smoking history was associated with nipple necrosis (p < 0.01). CONCLUSIONS: This series represents a high-volume experience with nipple-sparing mastectomy followed by immediate microsurgical reconstruction. When appropriately executed, it can deliver low complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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