Breast Surgery

Immediate Versus Delayed-Immediate Autologous Breast Reconstruction After Nipple-Sparing Mastectomy

Barnes, Laura L. MD^a; Patterson, Anne BS^a; Lem, Melinda BS^a,b; Holland, Michael C. MD^a; Lentz, Rachel MD^a,c; Sbitany, Hani MD^d; Piper, Merisa L. MD^a

Author Information

From the ^aDivision of Plastic and Reconstructive Surgery, University of California, San Francisco

^bDepartment of Plastic and Reconstructive Surgery, University of California, Irvine, CA

^cDivision of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA

^dDivision of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Received September 23, 2022, and accepted for publication, after revision February 21, 2023.

Conflicts of interest and sources of funding: none declared.

Presented at: International Confederation of Plastic Surgery Societies in Lima, Peru. May 19–21, 2022.

Reprints: Merisa Piper, MD, Suite M593, 505 Parnassus Ave, San Francisco, CA 94143. E-mail: [email protected].

Annals of Plastic Surgery 90(5):p 432-436, May 2023. | DOI: 10.1097/SAP.0000000000003539

Abstract

Introduction

Autologous reconstruction following nipple-sparing mastectomy (NSM) is either performed in a delayed-immediate fashion, with a tissue expander placed initially at the time of mastectomy and autologous reconstruction performed later, or immediately at the time of NSM. It has not been determined which method of reconstruction leads to more favorable patient outcomes and lower complication rates.

Methods

We performed a retrospective chart review of all patients who underwent autologous abdomen-based free flap breast reconstruction after NSM between January 2004 and September 2021. Patients were stratified into 2 groups by timing of reconstruction (immediate and delayed-immediate). All surgical complications were analyzed.

Results

One hundred one patients (151 breasts) underwent NSM followed by autologous abdomen-based free flap breast reconstruction during the defined time period. Fifty-nine patients (89 breasts) underwent immediate reconstruction, whereas 42 patients (62 breasts) underwent delayed-immediate reconstruction. Considering only the autologous stage of reconstruction in both groups, the immediate reconstruction group experienced significantly more delayed wound healing, wounds requiring reoperation, mastectomy skin flap necrosis, and nipple-areolar complex necrosis. Analysis of cumulative complications from all reconstructive surgeries revealed that the immediate reconstruction group still experienced significantly greater cumulative rates of mastectomy skin flap necrosis. However, the delayed-immediate reconstruction group experienced significantly greater cumulative rates of readmission, any infection, infection requiring PO antibiotics, and infection requiring IV antibiotics.

Conclusions

Immediate autologous breast reconstruction after NSM alleviates many issues seen with tissue expanders and delayed autologous reconstruction. Although mastectomy skin flap necrosis occurs at a significantly greater rate after immediate autologous reconstruction, it can often be managed conservatively.