Washington: Nipple-sparing techniques are a safe and effective option for mastectomy with immediate breast reconstruction, reports a study in the March issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
ASPS member surgeon Dr Amy S Colwell and colleagues of Massachusetts General Hospital conducted a large study observing outcomes of nipple-sparing mastectomy and immediate breast reconstruction in women undergoing surgery for treatment or prevention of breast cancer. They write, “Our review demonstrates that nipple-sparing mastectomy and immediate reconstruction has a high rate of success and a low rate of complications.”
Nipple-sparing procedures are an increasingly popular alternative for women undergoing mastectomy. Using this technique, the surgeon preserves the nipple and surrounding tissues for use in immediate breast reconstruction. In patients being treated for breast cancer, nipple-sparing mastectomy can be performed only if the nipple and surrounding tissues are completely free of cancer.
Between 2007 and 2012, Dr Colwell and colleagues performed a total of 500 nipple-sparing mastectomies in 285 women, average age 46 years. Fifty-four per cent of the women underwent “risk-reducing” mastectomy because of high genetic risk of breast cancer.
Nearly all of the women underwent immediate breast reconstruction, usually with implants. In about 60 per cent of patients, breast reconstruction with implants was completed at the same time as mastectomy. Most of the remaining women underwent two-stage reconstruction, including tissue expansion to increase the amount of skin available for implant-based reconstruction.
The overall complication rate was about 12 per cent. The most common complications were tissue death (necrosis) of part of the nipple or skin used for reconstruction. Cancer involving the nipple area was discovered in another four per cent of women. Even including these cases, the natural nipple was retained in the final reconstruction in more than 90 per cent of cases.
The study identified several important risk factors for complications. The complication rate was more than three times higher for women who smoked. Women who had received radiation therapy were also at increased risk.
Complications were also more common when the incision was placed around the nipple (periareolar incision). In contrast, the more commonly used incision under the breast fold (inframammary incision) was associated with a lower complication rate.
Nipple-sparing mastectomy has been “gaining traction as a preferred surgical option” for breast cancer treatment and for preventive mastectomy in women at high risk of breast cancer. It offers effective control of breast cancer risk while preserving the patient’s natural tissues for breast reconstruction. The new study is one of the first to detail the outcomes of breast reconstruction after nipple-sparing mastectomy.
With current techniques, the risk of complications appears lower than in initial reports of nipple-sparing mastectomy. At Massachusetts General Hospital, cancer surgeons and plastic surgeons follow a team approach to effectively control breast cancer risk while maximizing reconstruction outcomes.
“We are performing an increasing number of nipple-sparing mastectomy procedures as more breast oncology surgeons become comfortable with the procedure and with expansion of our indications for nipple-sparing surgery,” Dr Colwell and co-authors write. They increasingly use the inframammary incision based on patient preference, as well as the lower complication rate. The researchers add that they now perform single-stage reconstruction in more than two-thirds of women undergoing nipple-sparing mastectomy.
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