Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Recipient Vessel Selection in Immediate Breast Reconstruction with Free Abdominal Tissue Transfer after Nipple-Sparing Mastectomy

  • Yang, Sung-Jun (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eom, Jin-Sup (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Taik-Jong (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Sei-Hyun (Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Son, Byung-Ho (Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2012.02.13
  • Accepted : 2012.04.25
  • Published : 2012.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background : Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Methods : Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Results : Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. Conclusions : The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

Keywords

References

  1. Carlson GW. Skin sparing mastectomy: anatomic and technical considerations. Am Surg 1996;62:151-5.
  2. Carlson GW, Bostwick J 3rd, Styblo TM, et al. Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg 1997;225:570-5. https://doi.org/10.1097/00000658-199705000-00013
  3. Park EH, Kim JH, Son BH, et al. Recurrence and survival analysis in skin-sparing mastectomy with immediate reconstruction compared with conventional mastectomy. J Breast Cancer 2005;8:178-85. https://doi.org/10.4048/jbc.2005.8.4.178
  4. Wertheim U, Ozzello L. Neoplastic involvement of nipple and skin flap in carcinoma of the breast. Am J Surg Pathol 1980;4:543-9. https://doi.org/10.1097/00000478-198012000-00005
  5. Andersen JA, Gram JB, Pallesen RM. Involvement of the nipple and areola in breast cancer. Value of clinical findings. Scand J Plast Reconstr Surg 1981;15:39-42. https://doi.org/10.3109/02844318109103409
  6. Morimoto T, Komaki K, Inui K, et al. Involvement of nipple and areola in early breast cancer. Cancer 1985;55:2459-63. https://doi.org/10.1002/1097-0142(19850515)55:10<2459::AID-CNCR2820551025>3.0.CO;2-L
  7. Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999;6:609-13. https://doi.org/10.1007/s10434-999-0609-z
  8. Cense HA, Rutgers EJ, Lopes Cardozo M, et al. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 2001;27:521-6. https://doi.org/10.1053/ejso.2001.1130
  9. Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and au tologous reconstruction is an oncologically safe procedure. Ann Surg 2003;238:120-7.
  10. Mosahebi A, Ramakrishnan V, Gittos M, et al. Envelope mastectomy and immediate reconstruction (EMIR), improving outcome without oncological compromise. J Plast Reconstr Aesthet Surg 2006;59:1025-30. https://doi.org/10.1016/j.bjps.2005.11.029
  11. Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 2009;114:97-101. https://doi.org/10.1007/s10549-008-9968-6
  12. Gerber B, Krause A, Dieterich M, et al. The oncological safety of skin sparing mastectomy with conservation of the nippleareola complex and autologous reconstruction: an extended follow-up study. Ann Surg 2009;249:461-8. https://doi.org/10.1097/SLA.0b013e31819a044f
  13. Nahabedian MY, Tsangaris TN. Breast reconstruction following subcutaneous mastectomy for cancer: a critical appraisal of the nipple-areola complex. Plast Reconstr Surg 2006;117:1083-90. https://doi.org/10.1097/01.prs.0000202103.78284.97
  14. Mosahebi A, Ramakrishnan V, Gittos M, et al. Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction. Plast Reconstr Surg 2007;119:796-803. https://doi.org/10.1097/01.prs.0000251999.52374.09
  15. Denewer A, Farouk O. Can nipple-sparing mastectomy and immediate breast reconstruction with modified extended latissimus dorsi muscular flap improve the cosmetic and functional outcome among patients with breast carcinoma? World J Surg 2007;31:1169-77.
  16. Dao TN, Verheyden CN. TRAM flaps: a reconstructive option after bilateral nipple-sparing total mastectomy. Plast Reconstr Surg 2005;116:986-92. https://doi.org/10.1097/01.prs.0000178394.77346.53
  17. Suh HS, Lee TJ, Eom JS, et al. Immediate breast reconstruction with tram flap after nipple-areolar sparing mastectomy. J Korean Soc Plast Reconstr Surg 2006;33:570-6.
  18. Jabor MA, Shayani P, Collins DR Jr, et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002;110:457-63. https://doi.org/10.1097/00006534-200208000-00013
  19. Shestak KC, Gabriel A, Landecker A, et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 2002;110:780-6. https://doi.org/10.1097/00006534-200209010-00010
  20. Kronowitz SJ, Kuerer HM, Hunt KK, et al. Impact of sentinel lymph node biopsy on the evolution of breast reconstruction. Plast Reconstr Surg 2006;118:1089-99. https://doi.org/10.1097/01.prs.0000236794.73344.c4
  21. Moran SL, Nava G, Behnam AB, et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg 2003;111: 1876-82. https://doi.org/10.1097/01.PRS.0000056872.06003.7E
  22. Ferguson RE Jr, Yu P. Techniques of monitoring buried fasciocutaneous free flaps. Plast Reconstr Surg 2009;123:525-32. https://doi.org/10.1097/PRS.0b013e318196b9a3
  23. Kovach SJ, Georgiade GS. The "banked" TRAM: a method to insure mastectomy skin-flap survival. Ann Plast Surg 2006; 57:366-9. https://doi.org/10.1097/01.sap.0000221983.23546.09
  24. Liao EC, Labow BI, May JW Jr. Skin banking closure technique in immediate autologous breast reconstruction. Plast Reconstr Surg 2007;120:1133-6. https://doi.org/10.1097/01.prs.0000279144.50653.5a

Cited by

  1. Breast Reconstruction following Nipple-Sparing Mastectomy: A Systematic Review of the Literature with Pooled Analysis vol.132, pp.5, 2012, https://doi.org/10.1097/prs.0b013e3182a48b8a
  2. Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques vol.5, pp.3, 2014, https://doi.org/10.5306/wjco.v5.i3.478
  3. Necrotic Complications in Nipple-Sparing Mastectomy Followed by Immediate Breast Reconstruction: Systematic Review with Pooled Analysis vol.23, pp.2, 2012, https://doi.org/10.15596/arms.2014.23.2.51
  4. The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures vol.43, pp.4, 2016, https://doi.org/10.5999/aps.2016.43.4.328
  5. Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies vol.139, pp.6, 2017, https://doi.org/10.1097/prs.0000000000003340
  6. Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta‐analysis vol.37, pp.8, 2017, https://doi.org/10.1002/micr.30244
  7. Examining Length of Hospital Stay after Microsurgical Breast Reconstruction: Evaluation in a Case-Control Study vol.5, pp.12, 2012, https://doi.org/10.1097/gox.0000000000001588
  8. Skin-sparing Mastectomy and Immediate Nipple Graft for Large, Ptotic Breast vol.22, pp.4, 2012, https://doi.org/10.4048/jbc.2019.22.e52
  9. Choice of recipient vessels in muscle-sparing transverse rectus abdominis myocutaneous flap breast reconstruction: A comparative study vol.46, pp.2, 2012, https://doi.org/10.5999/aps.2018.00913
  10. Revisiting the internal mammaries as recipient vessels in breast reconstruction: considerations in current practice vol.184, pp.2, 2012, https://doi.org/10.1007/s10549-020-05878-x