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Immediate Implant-Based Breast Reconstruction following Total Skin-Sparing Mastectomy in Women with a History of Augmentation Mammaplasty: Assessing the Safety Profile

Sbitany, Hani M.D.; Wang, Frederick M.D.; Saeed, Lina B.A.; Alvarado, Michael M.D.; Ewing, Cheryl A. M.D.; Esserman, Laura J. M.D., M.B.A.; Foster, Robert D. M.D.

Plastic and Reconstructive Surgery: July 2014 - Volume 134 - Issue 1 - p 1–9
doi: 10.1097/PRS.0000000000000293
Breast: Original Articles
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Background: Preservation of the nipple–areolar complex with total skin-sparing mastectomy is becoming a popular mastectomy technique. As experience increases, the patient inclusion criteria for total skin sparing mastectomy expand. The authors assessed outcomes of total skin-sparing mastectomy and immediate prosthetic reconstruction in women with a prior history of augmentation mammaplasty.

Methods: Between 2005 and 2012, all women with a history of augmentation mammaplasty and implants in place, undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction, were prospectively tracked. Patient demographics, expander coverage type, adjuvant treatment, and incidence of complications were analyzed. Outcomes in these patients were compared with those of patients undergoing the same operation, without prior augmentation history.

Results: Thirty-four women with prior augmentation underwent total skin-sparing mastectomy and immediate tissue expander placement on 51 breasts. Comparison to the nonaugmentation group showed similar rates of superficial nipple necrosis (0 percent, p = 0.324), complete nipple necrosis (0 percent, p = 0.324), and skin flap necrosis (4 percent, p = 1.0). The prior augmentation group did have a higher rate of implant loss (10 percent, p = 0.515), with all but one of these occurring in irradiated patients.

Conclusions: Total skin-sparing mastectomy and immediate prosthetic reconstruction is a safe technique in women with a history of augmentation mammaplasty. The preferred reconstructive technique is immediate submuscular tissue expander placement. In the setting of no radiation history, this operation carries a safety profile similar to that of patients without a history of prior augmentation, and can be offered safely.


San Francisco, Calif.

From the Division of Plastic and Reconstructive Surgery, and the Division of Surgical Oncology, University of California, San Francisco.

Received for publication November 10, 2013; accepted January 6, 2014.

Disclosure: Dr. Sbitany is a member of the speaker’s bureau for LifeCell Corp. He did not receive any compensation or financial support for this study. The other authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Hani Sbitany, M.D., 505 Parnassus Avenue, Suite M-593, San Francisco, Calif. 94143,

©2014American Society of Plastic Surgeons