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American Association of Plastic Surgeons

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A Decade Of Nipple-sparing Mastectomy And Immediate Implant-based Breast Reconstruction: Lessons Learned
Amy S. Colwell, MD, Roberto Lorenzi Mendez, MD, Alex Lin, D.O., Justin McCarty, MD, Eric Liao, M.D., Alexandra Webster, B.S., Barbara L. Smith, MD, William G. Austen, Jr., MD.
Massachusetts General Hospital, Boston, MA, USA.

Purpose: Nipple-sparing mastectomy is commonly performed for breast cancer treatment or prevention. Prior outcomes research is limited by small sample size and conflicting data. We present one of the largest series in the literature for analysis. Methods: Retrospective single institution review was conducted from 2007-2018. Results: Our query found 2260 implant-based breast reconstructions after nipple-sparing mastectomy including 1508 direct-to-implant and 752 tissue expander-implant reconstructions. The average age was 47 and body mass index 24. The direct-to-implant cohort had more radiotherapy (17.6% vs. 13.2%, p=0.007) and chemotherapy (33.1% vs. 25.8%, p<0.001) while the tissue expander-implant group had more smokers (9.0% vs. 3.3%, p<0.001). Overall complications and nipple necrosis were higher in tissue expander reconstructions compared to direct to implant reconstruction (p<0.02 for each). Multivariable regression analysis revealed preoperative radiotherapy (OR 2.99, 95% C.I. 1.827-4.892, p<0.001), active smoking (OR 1.86, 95% C.I. 1.132-3.084), and periareolar incision (OR 3.528, 95% C.I. 1.399-8.893, p<0.001) to be the strongest predictors of overall complications and predictors of nipple necrosis (p<0.05). Tissue expander reconstruction had a significantly higher odds ratio for complications compared to direct-to-implant (OR 1.488, 95% C.I. 1.106-2.002, p=0.009). There was no difference in overall complications between reconstruction with acellular dermal matrix/ mesh compared to total or partial muscle coverage without ADM/mesh (OR 0.866, 95% C.I. 0.648-1.157, p=0.332). Conclusions: In this large series, radiation, smoking, and incision choice strongly predicted overall complications and nipple necrosis. Direct-to-implant reconstruction and reconstruction with acellular dermal matrix or mesh were not associated with an elevated risk of complications.


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