Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique
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REVIEW ARTICLE
Clinical outcomes of patients after nipple‑sparing mastectomy and reconstruction based on the expander/implant technique Uhi Toh1 · Miki Takenaka1 · Nobutaka Iwakuma1,2 · Yoshito Akagi1 Received: 23 June 2020 / Accepted: 8 September 2020 © The Author(s) 2020
Abstract Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple–areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients’ cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR. Keywords Breast cancer · Nipple-sparing mastectomy · Implant-based breast reconstruction
Introduction Breast cancer is the most commonly diagnosed cancer in women worldwide. In Japan alone, breast cancer was diagnosed in nearly 10,000 patients in 2016 [1, 2]. The incidence of breast cancer is also increasing significantly in line with improved detection and screening techniques. Despite this increase, the recent 5-year survival rate of patients diagnosed with breast cancer in Japan was 92.7% [3]. Because of the evolving management and treatment of breast cancer using combinations of systemic chemotherapy, endocrine therapy, and radiotherapy, the standard surgical treatment for breast cancer has undergone a paradigm shift toward lessaggressive surgery combining breast-conserving or breastreconstruction therapy for a higher emphasis on cosmesis [4, * Uhi Toh [email protected]‑u.ac.jp 1
Department of Surgery, Kurume University School of Medicine, 67 Asahi‑machi, Kurume 830‑0011, Japan
Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
2
5]. Compared with skin-sparing mastectomy (SSM) with or without nipple reconstruction, nipple-sparing mastectomy (NSM) preserving the nipple–areolar complex (NAC) with breast reconstruction improves the cosmesis, body image and nipple sensation of patients, with psychosocial and aesthetic benefits [6–9].
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