Reply: Nipple Loss following Nipple-Sparing Mastectomy

Colwell, Amy S. M.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 795e
doi: 10.1097/PRS.0000000000003090
Letters

Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street WACC 435, Boston, Mass. 02114, acolwell@partners.org

Article Outline
Back to Top | Article Outline

Sir:

I would like to thank the authors for the opportunity to clarify our study.1 In this article, we reviewed 775 consecutive nipple-sparing mastectomies with immediate reconstruction. The purpose of the article was to analyze reconstructions that suffered nipple loss to determine the incidence of cancer in the nipple specimen, the incidence of nipple removal for cosmesis or symmetry, and whether patients pursued further nipple reconstruction. This article was intended to guide plastic surgery discussions and counseling with patients. Our oncology group is actively following recurrence and disease-free survival, and thus these data were specifically omitted from the article.

Of the 775 mastectomies, 381 were performed for breast cancer and 394 had unilateral or bilateral prophylactic procedures. Fifty-one mastectomies had nipple loss. The incidence of total loss versus partial loss is shown in Figure 1. The cause of nipple loss is shown in Figure 2. Pathology reports from excised nipples are shown in Figure 3. These figures were included as part of the original article submission; however, the reviewers felt the figures did not contribute to the article.

Our study was conducted on consecutive mastectomy procedures and was not based on specific surgeons. Including data from several surgeons increases the generalizability of the study to the population at large as opposed to single-surgeon series. Arguably, the incidence of nipple loss secondary to ischemia is likely related to surgical technique, among other factors; however, ischemia-related complications were not the primary focus of this article and are better addressed in our article “Breast Reconstruction following Nipple-Sparing Mastectomy: Predictors of Complications, Reconstruction Outcomes, and 5-Year Trends.”2

In the latter article, we used multivariate logistic regression to determine predictors of ischemic complications. We found that preoperative radiotherapy (OR, 4.8; p = 0.047; 96 percent CI, 1.0197 to 23.169) and a periareolar incision (OR, 22.4; p < 0.001; 96 percent CI, 4.471 to 112.26) were positive predictors for nipple necrosis when controlling for other confounding variables. We agree that the outcomes from nipple-sparing mastectomy and reconstruction are worthy of continued analysis and study.

Back to Top | Article Outline

DISCLOSURE

The author is a consultant for Acelity and a recent advisory board member for Allergan.

Amy S. Colwell, M.D.

Division of Plastic and Reconstructive Surgery

Massachusetts General Hospital

Harvard Medical School

55 Fruit Street WACC 435

Boston, Mass. 02114

acolwell@partners.org

Back to Top | Article Outline

REFERENCES

1. Mastroianni M, Lin AM, Smith BL, Austen WG Jr, Colwell ASNipple loss following nipple-sparing mastectomy.Plast Reconstr Surg201613824e–30e
2. Colwell AS, Tessler O, Lin AM, et alBreast reconstruction following nipple-sparing mastectomy: Predictors of complications, reconstruction outcomes, and 5-year trends.Plast Reconstr Surg2014133496–506
Back to Top | Article Outline

GUIDELINES

Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2017American Society of Plastic Surgeons