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Time to Completion of Nipple Reconstruction: What Factors Are Involved?

Losken, Albert MD; Duggal, Claire S. MD; Desai, Karan A. MD; McCullough, Meghan C. BS; Gruszynski, Mark A. BS; Carlson, Grant W. MD

doi: 10.1097/SAP.0b013e318281ac61
Clinical Papers

Background Nipple reconstruction is often used as a marker for completion of the breast reconstructive process. The purpose of this study was to determine the average time to nipple reconstruction and the factors that influence this process.

Methods All patients who underwent postmastectomy breast reconstruction at Emory University between 2005 and 2011 were reviewed. Only those who had completed nipple reconstruction were included. Variables recorded were body mass index, age, smoking history, surgeon, presence of preoperative or postoperative chemotherapy or radiation therapy, type of reconstruction, timing of reconstruction, unilateral or bilateral reconstruction, and complication history. Time to completion of nipple reconstruction was calculated and comparisons were made.

Results A total of 451 patients completed nipple reconstruction (128 implant reconstructions, 120 latissimus plus implant reconstructions, 23 latissimus only reconstructions, and 180 transverse rectus abdominus myocutaneous flap [TRAM] or deep inferior epigastric perforator flap [DIEP] reconstructions). Average time to nipple reconstruction was 12.25 months. Patients who underwent TRAM or DIEP flaps completed reconstruction on average earlier than implant-based reconstruction and latissimus-only reconstruction (8.67 vs 11.2 and 11.3 months, respectively, P = 0.0016). Patients who underwent postoperative chemotherapy or radiation therapy were delayed compared to those that did not (11.3 vs 9.33 and 13.87 vs 9.87 months, P = 0.0315 and P = 0.0052). Timing of completion was also dependent on attending surgeon (9.8 and 11.43 months for the 2 senior surgeons, P = 0.0135) and presence of complications (10.3 compared to 9.77 months for patients without complications, P = 0.0334). Body mass index, smoking history, preoperative chemotherapy or radiation therapy, timing of reconstruction, and unilateral versus bilateral reconstruction did not affect time to nipple reconstruction.

Conclusions Type of reconstruction, surgeon, presence of complications, and need for postoperative chemotherapy or radiation therapy all affect timing to completion of breast reconstruction. Patients should be counseled as to these factors at the initial consultation to set appropriate expectations.

From the Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA.

Received November 26, 2012, and accepted for publication, after revision, December 5, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Albert Losken, MD, Emory Division of Plastic and Reconstructive Surgery, 550 Peachtree St, Suite 9, Atlanta, GA 30308. E-mail:

This paper was accepted for presentation at the Southeastern Society of Plastic Surgeons Meeting in Amelia Island, FL, 2012.

© 2013 by Lippincott Williams & Wilkins