Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

  • Cho, Jin-Woo (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine) ;
  • Yoon, Eul-Sik (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine) ;
  • You, Hi-Jin (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine) ;
  • Kim, Hyon-Surk (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine) ;
  • Lee, Byung-Il (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine) ;
  • Park, Seung-Ha (Department of Plastic and Reconstructive Surgery, Korea University College of Medicine)
  • Received : 2015.03.04
  • Accepted : 2015.06.01
  • Published : 2015.09.15
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Abstract

Background Autologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution. Methods We reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis. Results Eighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery. Conclusions NAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

Keywords

References

  1. Spear SL, Hannan CM, Willey SC, et al. Nipple-sparing mastectomy. Plast Reconstr Surg 2009;123:1665-73. https://doi.org/10.1097/PRS.0b013e3181a64d94
  2. Komorowski AL, Zanini V, Regolo L, et al. Necrotic complications after nipple- and areola-sparing mastectomy. World J Surg 2006;30:1410-3. https://doi.org/10.1007/s00268-005-0650-4
  3. Endara M, Chen D, Verma K, et al. Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis. Plast Reconstr Surg 2013; 132:1043-54. https://doi.org/10.1097/PRS.0b013e3182a48b8a
  4. Kim HR, Lim JS, Kim SM, et al. One-stage nipple and breast reconstruction following areola-sparing mastectomy. Arch Plast Surg 2013;40:553-8. https://doi.org/10.5999/aps.2013.40.5.553
  5. Tan BK, Chim H, Ng ZY, et al. Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women. Arch Plast Surg 2014; 41:366-73. https://doi.org/10.5999/aps.2014.41.4.366
  6. Gerber B, Krause A, Dieterich M, et al. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 2009;249:461-8. https://doi.org/10.1097/SLA.0b013e31819a044f
  7. Kneubil MC, Lohsiriwat V, Curigliano G, et al. Risk of locoregional recurrence in patients with false-negative frozen section or close margins of retroareolar specimen in nipple-sparing mastectomy. Ann Surg Oncol 2012;19:4117-23. https://doi.org/10.1245/s10434-012-2514-0
  8. Moyer HR, Ghazi B, Daniel JR, et al. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg 2012;68:446-50. https://doi.org/10.1097/SAP.0b013e3182394bba
  9. Carlson GW, Chu CK, Moyer HR, et al. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J 2014;20: 69-73. https://doi.org/10.1111/tbj.12208
  10. 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. https://doi.org/10.1097/01.prs.0000438056.67375.75
  11. Piper M, Peled AW, Foster RD, et al. Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg 2013;70:435-7. https://doi.org/10.1097/SAP.0b013e31827e5333
  12. van Deventer PV. The blood supply to the nipple-areola complex of the human mammary gland. Aesthetic Plast Surg 2004; 28:393-8. https://doi.org/10.1007/s00266-003-7113-9
  13. 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
  14. 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
  15. Park SW, Lee TJ, Kim EK, et al. Managing necrosis of the nipple-areola complex in breast reconstruction after nipple-sparing mastectomy: immediate nipple-areola complex reconstruction with banked skin. Plast Reconstr Surg 2014;133:73e-74e. https://doi.org/10.1097/01.prs.0000436805.58165.d3
  16. Reichl H, Hladik M, Wechselberger G. Skin banking: treatment option for native skin necrosis following skin-sparing mastectomy and previous breast irradiation. Microsurgery 2011;31:314-7. https://doi.org/10.1002/micr.20871
  17. Ahmed AK, Hahn DE, Hage JJ, et al. Temporary banking of the nipple-areola complex in 97 skin-sparing mastectomies. Plast Reconstr Surg 2011;127:531-9. https://doi.org/10.1097/PRS.0b013e3181fed578
  18. Gould DJ, Hunt KK, Liu J, et al. Impact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nipple-sparing mastectomy. Plast Reconstr Surg 2013; 132:330e-338e. https://doi.org/10.1097/PRS.0b013e31829ace49
  19. Dent BL, Small K, Swistel A, et al. Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment. Aesthet Surg J 2014;34:560-70. https://doi.org/10.1177/1090820X14528352
  20. Peled AW, Foster RD, Ligh C, et al. Impact of total skin-sparing mastectomy incision type on reconstructive complications following radiation therapy. Plast Reconstr Surg 2014; 134:169-75.

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