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Microsurgical Breast Reconstruction for Nipple-Sparing Mastectomy

Tanna, Neil M.D., M.B.A.; Broer, P. Niclas M.D.; Weichman, Katie E. M.D.; Alperovich, Michael M.D.; Ahn, Christina Y. M.D.; Allen, Robert J. Sr. M.D.; Choi, Mihye M.D.; Karp, Nolan S. M.D.; Saadeh, Pierre B. M.D.; Levine, Jamie P. M.D.

Plastic and Reconstructive Surgery: February 2013 - Volume 131 - Issue 2 - p 139e–147e
doi: 10.1097/PRS.0b013e3182789b51
Breast: Original Articles
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Background: Nipple-sparing mastectomy warrants thorough preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. To the authors' knowledge, this review represents the largest series of microsurgical breast reconstructions following nipple-sparing mastectomies.

Methods: All patients undergoing nipple-sparing mastectomy with microsurgical immediate breast reconstruction treated at New York University Medical Center (2007–2011) were identified. Patient demographics, breast cancer history, intraoperative details, complications, and revision operations were examined. Descriptive statistical analysis, including t test or regression analysis, was performed.

Results: In 51 patients, 85 free flap breast reconstructions (n = 85) were performed. The majority of flaps were performed for prophylactic indications [n = 55 (64.7 percent)], mostly through vertical incisions [n = 40 (47.0 percent)]. Donor sites included abdominally based [n = 66 (77.6 percent)], profunda artery perforator [n = 12 (14.1 percent)], transverse upper gracilis [n = 6 (7.0 percent)], and superior gluteal artery perforator [n = 1 (1.2 percent)] flaps. The most common complications were mastectomy skin flap necrosis [n = 11 (12.7 percent)] and nipple necrosis [n = 11 (12.7 percent)]. There was no correlation between mastectomy skin flap or nipple necrosis and choice of incision, mastectomy specimen weight, body mass index, or age (p > 0.05). However, smoking history was associated with nipple necrosis (p < 0.01).

Conclusions: This series represents a high-volume experience with nipple-sparing mastectomy followed by immediate microsurgical reconstruction. When appropriately executed, it can deliver low complication rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

New York, N.Y.

From the Institute of Reconstructive Plastic Surgery, New York University.

Received for publication May 31, 2012; accepted August 9, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Jamie P. Levine, M.D.; 530 First Avenue, Suite 8Y, New York, N.Y. 10016, jamie.levine@nyumc.org

©2013American Society of Plastic Surgeons