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Breast Reconstruction following Nipple-Sparing Mastectomy: A Systematic Review of the Literature with Pooled Analysis

Endara, Matthew M.D.; Chen, Duan B.A.; Verma, Kapil M.D.; Nahabedian, Maurice Y. M.D.; Spear, Scott L. M.D.

Plastic and Reconstructive Surgery: November 2013 - Volume 132 - Issue 5 - p 1043–1054
doi: 10.1097/PRS.0b013e3182a48b8a
Breast: Outcomes Article

Background: Nipple-sparing mastectomy is a controversial option for breast cancer treatment due to locoregional recurrence and distant metastasis. In addition to these oncologic factors, technical factors such as ideal incision type or reconstructive options are also debatable. This systematic review examines current trends with nipple-sparing mastectomy, including selection criteria, locoregional and distant metastasis rates, incision choice, and reconstructive options.

Methods: Systematic electronic searches were performed in the PubMed and Ovid databases using search terms for studies reporting outcomes following nipple-sparing mastectomy and all forms of reconstruction. Studies between 1970 and 2013 were reviewed. Pooled descriptive statistics with separate analyses for incision type and reconstructive method were performed.

Results: Forty-eight studies met inclusion criteria, yielding 6615 nipple-sparing mastectomies for analysis. The overall pooled complication rate was 22 percent, the nipple necrosis rate was 7 percent, the locoregional recurrence rate was 1.8 percent, and the distant metastasis rate was 2.2 percent. Comparing combined patient cohorts for two-stage expander to implant, one-stage direct to implant, and autologous reconstruction demonstrated overall complication rates of 52.8, 16.7, and 23.7 percent and nipple necrosis rates of 4.5, 4.1, and 17.3 percent, respectively. Incision types were divided into five categories: radial, periareolar/circumareolar, inframammary, mastopexy, and transareolar, with nipple necrosis rates of 8.83, 17.81, 9.09, 4.76, and 81.82 percent, respectively

Conclusions: Nipple-sparing mastectomy appears to be an oncologically safe option for properly selected patients, with low rates of locoregional and distant metastasis. Overall complication and nipple necrosis rates are affected by incision location and reconstruction method. Randomized controlled trials are warranted to determine best incision and reconstructive methods.


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Washington, D.C.

From the Department of Plastic and Reconstructive Surgery, Georgetown University Hospital.

Received for publication April 15, 2013; accepted June 3, 2013.

Disclosure: Dr. Spear is a consultant for LifeCell and Allergan. Dr. Nahabedian is a consultant for LifeCell. The remaining authors have no financial interest in any of the products or devices mentioned in this article. No funding was provided for data collection or for writing this article.

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Scott L. Spear, M.D., Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road NW, 1st Floor, PHC Building, Washington, D.C. 20007

©2013American Society of Plastic Surgeons