Early postoperative complications and local relapses after nipple sparing mastectomy and immediate breast reconstruction using silicone implants

  • Vladimir Selaković Oncology Institute of Vojvodina
  • Milan Ranisavljević Oncology Institute of Vojvodina
  • Zoran Radovanović Oncology Institute of Vojvodina
  • Ferenc Vicko Oncology Institute of Vojvodina
  • Dejan Lukić Oncology Institute of Vojvodina
  • Mladen Đurić Oncology Institute of Vojvodina
Keywords: Nipples, Local relapses, Breast cancer, Postoperative Complications, Mastectomy,

Abstract


Purpose of this study was to evaluate early complications and risk factors associated with nipple sparing mastectomy and immediate breast reconstruction. Methods: This retrospective study was made using data from 246 breast cancer patients treated at the Oncology Institute of Vojvodina in the period from January 2010 to December 2015. In all patients nipple sparing mastectomy was performed along with primary breast reconstruction. Results: The mean indication for nipple sparing mastectomy was multicentricity of the tumor (114 patients; 46.3%). The majority of surgically treated patients were in stage II of the disease. The total percentage of local relapses after the nipple sparing mastectomy was 1.6% (4 patients). Total percentage of early complications was 15% (37 patients). Median follow-up after nipple sparing mastectomy was 260 weeks (ranging from 417 to 104 weeks). Conclusion: Primary reconstruction of the breasts using heterologous implants is standard surgical procedure for breast cancer that does not lead to increased number of complications, nor to increased percentage of the local recurrence.

References

Freeman BS: Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast Reconstr Surg 1962; 30:676–682.

Lee SB, Lee JW, Son BH, Eom JS, Kim EK, Lee TJ,et all. Oncologic safety of skin-sparing mastectomy followed by immediate reconstruction in young patients with breast cancer. Asian J Surg. 2018; 13: 1015-9584 (17): 30723-6.

Lago V, Maisto V, Gimenez-Climent J, Vila J, Vazquez C, Estevan R. Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study. Breast J. 2018 May; (3):298-303.

Jakub JW, Peled AW, Gray RJ, Greenup RA, Kiluk JV, Sacchini V, et all. Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in a Population With BRCA Mutations: A Multi-institutional Study. JAMA Surg. 2018;153 (2):123-129.

Miyake R, Kinoshita S, Shimada N, Uchida K, Takeyama H, Morikawa T. Preservation of the nipple-areola complex in skin-sparing mastectomy for early breast cancer. Surg Today. 2018; 48(6):591-597.

Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–127

Voltura AM, Tsangaris TN, Rosson GD, et al. Nipple-sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria. Ann Surg Oncol. 2008; 15:3396–3401

Rusby JE, Smith BL, Gui GP. Nipple-sparing mastectomy. Br J Surg. 2010; 97:305–316.

Odom EB, Parikh RP, Um G, Kantola SW, Cyr AE, Margenthaler JA, Tenenbaum MM, Myckatyn TM. Nipple-Sparing Mastectomy Incisions for Cancer Extirpation Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes. Plast Reconstr Surg. 2018;142(1):13-26.

Caruso F, Ferrara M, Castiglione G, et al: Nipple sparing subcutaneous mastectomy: sixty-six months follow-up. Eur J Surg Oncol. 2006;32:937–940

Sacchini V, Pinotti JA, Barros AC, et al: Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surgeons 2006; 203:704–714

Harness JK, Vetter TS, Salibian AH: Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol. 2011;18:917-22

Spear SL, Hannan CM, Willey SC, Cocilovo C. Nipple-sparing mastectomy. Plast Reconstr Surg. 2009; 123:1665–1673.

Garcia-Etienne CA, Cody HS, III, Disa JJ, Cordeiro P, Sacchini V. Nipple-sparing mastectomy: initial experience at the Memorial Sloan-Kettering Cancer Center and a comprehensive review of literature. Breast J. 2009; 15:440–449.

Cense HA, Rutgers EJ Th, Lopes Cardozo M, Van Lanschot JJB: Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 2001;27:521–526.

Newman LA, Kuerer HM, Hunt KK, et al: Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 1999; 6(7): 671–675.

Spiegel A, Butler C: Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction. Plast Reconstr Surg 2003;111:706–711

Mariscotti G, Durando M, Houssami N, Berzovini CM, Esposito F, Fasciano M, et all. Preoperative MRI evaluation of lesion-nipple distance in breast cancer patients: thresholds for predicting occult nipple-areola complex involvement. Clin Radiol. 2018;73(8):735-743.

Zeng J, Mercado C, Axelrod D, Guth A, Darvishian F. Missing targets after nipple-sparing mastectomy: A multi-disciplinary approach to avoid an undesirable outcome. Breast J. 2018;24(4):678-679.

Komorowski AL, Zanini V, Regolo L, Carolei A, Wysocki WM, Costa A: Necrotic complications after nipple- and areola-sparing mastectomy. World J Surg 2006;30:1410–1413

Elston JB, Prabhakaran S, Lleshi A, Castillo B, Sun W, Kumar A, et all. Complications and Recurrence in Implant-Sparing Oncologic Breast Surgery. Ann Plast Surg. 2017;78(6S Suppl 5):269-S274.

Laporta R, Longo B, Sorotos M, Farcomeni A, Patti C, Mastrangeli MR, et all. Breast reconstruction following nipple-sparing mastectomy: clinical outcomes and risk factors related complications. J Plast Surg Hand Surg. 2017;51(6):427-435.

De Vita R, Zoccali G, Buccheri EM, Costantini M, Botti C, Pozzi M. Outcome Evaluation after 2023 Nipple-Sparing Mastectomies: Our Experience. Plast Reconstr Surg. 2017;139(2):335-347.

Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, et all. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast. 2017;34 (1):82-84.

Frey JD, Choi M, Karp NS. The Effect of Neoadjuvant Chemotherapy Compared to Adjuvant Chemotherapy in Healing after Nipple-Sparing Mastectomy. Plast Reconstr Surg. 2017;139(1):10-19.

Published
2019/02/04
Section
Original Scientific Paper