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Implant-based Breast Reconstruction After Nipple-sparing Mastectomy: A Comparison Between 1 and 2 Stages

Duraes, Eliana F. R. MD, PhD; Scomacao, Isis MD; Xia, Thomas BS; Younis, Joseph BS; Wyrick, Jonathan BS; Bernard, Steven MD; Schwarz, Graham S. MD; Moreira, Andrea MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 17
doi: 10.1097/01.GOX.0000584284.37875.87
Breast Abstracts

Cleveland Clinic, Cleveland, OH

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Nipple-sparing mastectomy (NSM) is reserved for patients who meet specific criteria to optimize considerations in the oncologic domain and reduce complications.1 Trend toward the development of more broader reconstructive indications for NSM is directly related to patient demand and the possibility to achieve a better esthetic outcomes.2 Several studies have demonstrated the safety of this procedure in patients with increased risk factors.3,4 Well-selected high-risk patients can safely undergo NSM and implant reconstruction in 1 stage or 2 stages.

PURPOSE: To compare risk factors and complications in patients after NSM and implant-based breast reconstruction.

METHODS: A retrospective chart review was performed in a tertiary institution from 2016 to 2018. All patients who underwent NSM followed by 2-stage or direct-to-implant (DTI) reconstruction had their information collected per reconstructed breast. Patient demographics, previous surgeries, smoking status, radiotherapy history, surgical information, and postoperative complications (delayed wound healing, dehiscence, mastectomy flap necrosis, and infection) were collected.

RESULTS: A total of 217 breasts were analyzed: 110 (50.69%) underwent DTI and 107 (49.30%) 2-stage reconstructions. DTI group had patients with slightly older age (48.88 ± 12.78 versus 45.31 ± 10.8; P = 0.02), higher body mass index (27.35 ± 5.97 versus 24.89 ± 4.95; P = 0.001), higher mastectomy weight (455.62 ± 229.05 g versus 372.213 ± 213.06 g; P = 0.006), and higher ptosis grades (P = 0.010). The groups were similar for smoking status, history of radiation, and prophylactic mastectomy. DTI group had more prepectoral reconstructions than TE group (65 [59.09%] versus 22 [20.56%]) and used acellular dermal grafts more frequently (110 [100%] versus 83 [77.6%]) (P < 0.001). There were no significant differences in complication rates between the groups (28.97% versus 33.63%; P = 0.47) and reoperation rates (12.14% versus 15.45%; P = 0.56). Number of revision surgery was similar between both groups (P = 0.17). The number of surgeries required on the entire reconstruction process was bigger on the 2 stages group 2.48 ± 1 versus 1.4 ± 0.75 (P < 0.001). Successful implant-based reconstructions were achieved in 90.81% on TE group and 96.36% on DTI group (P = 0.121).

CONCLUSION: Implant-based breast reconstruction after NSM can be successfully achieved in 1 or 2 stages with similar rates of complication, reoperation, and revision. The patients who underwent DTI reconstructions had similar rates of successful reconstructions despite the higher body mass index, older age, higher mastectomy specimens’ weights, and higher preoperative ptosis grades.


1. Spear SL, Willey SC, Feldman ED, et al. Nipple-sparing mastectomy for prophylactic and therapeutic indications. Plast Reconstr Surg. 2011;128:1005–1014.

2. Pontell ME, Saad N, Brown A, et al. Single stage nipple-sparing mastectomy and reduction mastopexy in the ptotic breast. Plast Surg Int. 2018;2018:9205805.

3. Schwartz JC. A new approach to nipple-sparing mastectomy and reconstruction in the high risk ptotic patient. Plast Reconstr Surg Glob Open. 2018;6:e1779.

4. Jadeja P, Ha R, Rohde C, et al. Expanding the criteria for nipple-sparing mastectomy in patients with poor prognostic features. Clin Breast Cancer. 2018;18:229–233.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.