Autologous Vs Implant Based Breast Reconstruction After Nipple Sparing Mastectomy: Complications, Patient Reported And Aesthetic Outcomes
Cagri Cakmakoglu, M.D1, Isis Scomacao, M.D1, Joan Lee, B.S2, Andrea Moreira, M.D1, Risal Djohan, M.D1, Steven Bernard, M.D1, Eliana Duraes, M.D1, Thomas Xia, B.S2, Graham Schwarz, M.D1.
1Cleveland Clinic Foundation, Cleveland, OH, USA, 2Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Background: Nipple-sparing mastectomy (NSM) is a common approach for breast cancer treatment. The aim of this study is to compare breast aesthetics, patient satisfaction, and complications in patients who underwent NSM with autologous vs implant-based breast reconstruction.
Methods: Chart reviews of NSM patients with autologous and implant-based breast reconstructions were performed. The post-operative BreastQ and photos were evaluated using a multi-parameter breast specific scale. Aesthetic, patient-reported outcomes, and complications were analyzed.
Results: A total of 990 breasts within the implant group and 202 breasts within the autologous group were evaluated: 44% of the implant and 70% of the autologous group had post-operative photos, and 29% and 37% answered the BreastQ respectively.
Patient-reported satisfactions with breast and nipple outcomes were statistically, significantly higher within the autologous group. There were no differences in satisfaction with regard to psychosocial, sexual, and physical well-being chest scores.
Negative correlators with breast aesthetics were mastectomy with wise pattern skin incision and radiation therapy; a positive correlator was mastectomy with inframammary fold incision.
Overall complication rates were more frequent in the autologous vs implant reconstruction group. In the first 30 days post-operatively, the most frequent complication was skin necrosis/delayed wound healing: 49% vs 6.3% respectively. Nipple complications in the autologous group constituted 16%. In the autologous group, NAC reconstruction was performed in 10% of patients due to nipple necrosis.
Conclusion: Compared to implant-based reconstruction after NSM, autologous reconstruction may lead to better overall aesthetics and patient-reported outcomes, however with a higher rate of complications.
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