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Nipple-sparing mastectomy, immediate reconstruction effective, safe in patients with prior breast surgery

Nipple-sparing mastectomy and immediate reconstruction can be performed in patients with prior breast surgery with no significant increase in nipple loss, according to a retrospective study in Plastic and Reconstructive Surgery Journal.

A total of 444 patients underwent 775 immediate breast reconstructions after nipple-sparing mastectomy. Of these, 160 patients (187 reconstructions) had undergone previous breast surgery.

Demographics were similar for both groups, except patients who previously had breast surgery were older.

Previous breast surgery was not a significant risk factor for ischemic complications or nipple loss.

The researchers warned against extending prior irradiated incisions as that was predictive of skin flap necrosis.

There were no significant differences in overall complication rates or individual complications of skin flap necrosis, nipple or nipple-areola complex necrosis, hematoma, seroma and implant loss between patients who had prior breast surgery and those who did not.

Both groups had very low reconstructive failure rates and no differences in nipple loss.

The researchers found that during the study period, they were more likely to perform nipple-sparing mastectomy on patients who had more recent operations.

Radiation treatment was a predictor of skin flap necrosis, infection and overall complications.

The extension of a previously irradiated scar was associated with increased mastectomy flap necrosis, therefore the researchers do not recommend this practice.

With proper preoperative planning, nipple-sparing mastectomy and immediate reconstruction is an option for patients with prior breast surgery and doesn’t increase in nipple loss. –by Abigail Sutton

Disclosure: Frederick reported no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.