Do Nipple Necrosis Rates Differ in Prepectoral Versus Submuscular Implant-Based Reconstruction After Nipple-Sparing Mast
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Do Nipple Necrosis Rates Differ in Prepectoral Versus Submuscular Implant-Based Reconstruction After Nipple-Sparing Mastectomy? Sterling E. Braun, MD2, Mollie Dreicer, BS3, James A. Butterworth, MD2, and Kelsey E. Larson, MD1 Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, Kansas City, KS; 2Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS; 3University of Kansas School of Medicine, Kansas City, KS 1
ABSTRACT Background. Nipple-sparing mastectomy (NSM) has become increasingly popular, given its oncologic safety and preserved nipple areolar complex (NAC) aesthetics. Reconstruction has recently shifted from traditional submuscular (SM) to prepectoral (PP) implant placement. It remains unclear how the plane of implant placement might affect NAC perfusion. Our goal was to assess postoperative outcomes following NSM with SM versus PP implant placement. Methods. A retrospective single-institution review was performed of all patients undergoing NSM and immediate breast reconstruction in either the PP or SM plane from January 2015 to June 2019. Clinicopathologic details and 90-day complication rates were collected. SM and PP group complications were compared using Chi square analysis. Results. A total of 288 breasts (160 patients) were included, including SM in 79 cases (44 patients) and PP in 209 cases (116 patients). Clinicopathologic features between groups were similar. Overall, the rate of NAC necrosis was 15.1%, with no differences between the SM and PP cohorts (p = 0.79). In cases of NAC necrosis, there was no difference between the SM and PP groups in return to the operating room for debridement (p = 1.0) or explant (p = 0.33).
Ó Society of Surgical Oncology 2020 First Received: 29 April 2020 Accepted: 26 May 2020 S. E. Braun, MD e-mail: [email protected]
Conclusions. In our cohort, immediate implant-based reconstruction in the SM and PP planes following NSM was equally safe with respect to postoperative complications and NAC ischemia.
Nipple-sparing mastectomy (NSM) has become increasingly popular, given its demonstrated oncologic safety and preserved aesthetics of the nipple areolar complex (NAC).1–3 However, the risk of NAC ischemia following NSM remains a significant concern, and reported incidences in the literature range from 7 to 37.5%.4–6 Strategies for mitigating the risk of NAC ischemia include careful patient selection and operative planning.7,8 Plastic surgeons have recently shifted from traditional submuscular (SM) implant placement to using the prepectoral (PP) plane in reconstruction. The benefits of the shift include improved aesthetics, decreased postoperative pain, and long-term improvements in avoidance of animation deformity and associated discomfort.9–11 Furthermore, there is a lower risk of capsular contracture in patients who undergo adjuvant radiation with PP reconstruction.12 However, the effect of immediate PP implant placement on NAC ischemia and necrosis following NSM remains u
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