Immediate Implant-Based Breast Reconstruction following Total Skin-Sparing Mastectomy
- 1 September 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 134 (3), 396-404
- https://doi.org/10.1097/prs.0000000000000466
Abstract
Radiation therapy is increasingly used in breast cancer therapy. With total skin-sparing mastectomy and nipple/areola complex preservation, defining the risks of various treatment regimens for morbidity is important, in the setting of immediate prosthetic reconstruction. The authors assessed the effects of premastectomy and postmastectomy radiation therapy on outcomes in total skin-sparing mastectomy and immediate prosthetic reconstruction. All patients undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction at the authors' institution between 2006 and 2012 were identified. Cohort 1 included patients undergoing total skin-sparing mastectomy and reconstruction with no radiation. Cohort 2 included patients with a prior history of radiation before total skin-sparing mastectomy and reconstruction. Cohort 3 included patients undergoing radiation after total skin-sparing mastectomy and reconstruction. A total of 580 patients underwent 903 breast reconstructions following total skin-sparing mastectomy. Cohort 1 included 727 breasts, cohort 2 included 63 breasts, and cohort 3 included 113 breasts. Any radiation delivery caused an increased rate of infection requiring antibiotics (21.6 percent, p = 0.00) and an increased risk of expander/implant loss (18.75 percent, p = 0.00). Cohort 2 had a higher risk of wound breakdown (p = 0.012). All cohorts showed similar low rates of nipple/areola necrosis. Both preoperative and postoperative radiation following total skin-sparing mastectomy and immediate prosthetic reconstruction result in higher, but acceptable, complication risks. Complications related to nipple/areola preservation are similar to those in nonradiated patients and in those undergoing skin-sparing mastectomy. Thus, nipple/areola complex preservation is safe in women undergoing radiation therapy. Therapeutic, III.Keywords
This publication has 29 references indexed in Scilit:
- Nipple Skin-Sparing Mastectomy is Feasible for Advanced DiseaseAnnals of Surgical Oncology, 2013
- Lobular histology and response to neoadjuvant chemotherapy in invasive breast cancerBreast Cancer Research and Treatment, 2012
- Nipple-Sparing Mastectomy for Prophylactic and Therapeutic IndicationsPlastic and Reconstructive Surgery, 2011
- Nipple-Sparing Mastectomy for Breast Cancer and Risk-Reducing Surgery: The Memorial Sloan-Kettering Cancer Center ExperienceAnnals of Surgical Oncology, 2011
- Outcome of Different Timings of Radiotherapy in Implant-Based Breast ReconstructionsPlastic and Reconstructive Surgery, 2011
- Postmastectomy Radiation Therapy and Breast ReconstructionAnnals of Plastic Surgery, 2010
- Nipple-sparing mastectomyBritish Journal of Surgery, 2010
- AlloDerm Performance in the Setting of Prosthetic Breast Surgery, Infection, and IrradiationPlastic and Reconstructive Surgery, 2009
- Total Skin-Sparing MastectomyAnnals of Surgery, 2009
- A Single Surgeon???s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part I. A Prospective Analysis of Early ComplicationsPlastic and Reconstructive Surgery, 2006