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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 483-493
DOI: 10.5999/aps.2021.00374
Breast/Trunk
Original Article

Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients

Chun-Lin Su 
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Taiwan
,
Jia-Ruei Yang 
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Taiwan
,
Wen-Ling Kuo 
Department of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan
College of Medicine, Chang Gung University, Taoyuan
,
Shin-Cheh Chen 
Department of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan
College of Medicine, Chang Gung University, Taoyuan
,
David Chon-Fok Cheong 
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Taiwan
College of Medicine, Chang Gung University, Taoyuan
,
Jung-Ju Huang 
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Taiwan
College of Medicine, Chang Gung University, Taoyuan
Center for Tissue Engineering, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.

Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.

Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025).

Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.

Keywords

Mammaplasty - Breast implant - Mastectomy - Treatment outcomes


Publication History

Received: 20 February 2021

Accepted: 29 July 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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Comment to this article:

Commentary: Direct-to-Implant Breast Reconstruction following Nipple-sparing Mastectomy: Predictive Factors of Adverse Surgical Outcomes in Asian PatientsArch Plast Surg 2021; 48(05): V2-V2
DOI: 10.1055/s-0043-1777249

 

  • REFERENCES

  • 1 Sacchini V, Pinotti JA, Barros AC. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?. J Am Coll Surg 2006; 203: 704-14
    CrossrefPubMedSearch in Google Scholar
  • 2 Gerber B, Krause A, Dieterich M. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 2009; 249: 461-8
    CrossrefPubMedSearch in Google Scholar
  • 3 Munhoz AM, Aldrighi CM, Montag E. Clinical outcomes following nipple-areola-sparing mastectomy with immediate implant-based breast reconstruction: a 12-year experience with an analysis of patient and breast-related factors for complications. Breast Cancer Res Treat 2013; 140: 545-55
    CrossrefPubMedSearch in Google Scholar
  • 4 Pek WS, Tan BK, Ru Ng YY. Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: aesthetic outcomes and mitigating nipple-areolar complex necrosis. Arch Plast Surg 2018; 45: 229-38
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Colwell AS, Christensen JM. Nipple-sparing mastectomy and direct-to-implant breast reconstruction. Plast Reconstr Surg 2017; 140: 44S-50S
    CrossrefPubMedSearch in Google Scholar
  • 6 de Vita R, Buccheri EM. Nipple sparing mastectomy and direct to implant breast reconstruction, validation of the safe procedure through the use of laser assisted indocyanine green fluorescent angiography. Gland Surg 2018; 7: 258-66
    CrossrefPubMedSearch in Google Scholar
  • 7 Boneti C, Yuen J, Santiago C. Oncologic safety of nipple skin-sparing or total skin-sparing mastectomies with immediate reconstruction. J Am Coll Surg 2011; 212: 686-93
    CrossrefPubMedSearch in Google Scholar
  • 8 Azouz V, Lopez S, Wagner DS. Surgeon-controlled comparison of direct-to-implant and 2-stage tissue expander-implant immediate breast reconstruction outcomes. Ann Plast Surg 2018; 80: 212-6
    CrossrefPubMedSearch in Google Scholar
  • 9 Grover R, Rueda S, Gurunluoglu R. Is single-stage prosthetic reconstruction cost effective? A cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients. Plast Reconstr Surg 2017; 139: 1204e-1205e
    CrossrefPubMedSearch in Google Scholar
  • 10 Wang HY, Ali RS, Chen SC. One-stage immediate breast reconstruction with implant following skin-sparing mastectomy in Asian patients. Ann Plast Surg 2008; 60: 362-6
    CrossrefPubMedSearch in Google Scholar
  • 11 Colwell AS, Damjanovic B, Zahedi B. et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128: 1170-8
    CrossrefPubMedSearch in Google Scholar
  • 12 Vardanian AJ, Clayton JL, Roostaeian J. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg 2011; 128: 403e-410e
    CrossrefPubMedSearch in Google Scholar
  • 13 Ho G, Nguyen TJ, Shahabi A. A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg 2012; 68: 346-56
    CrossrefPubMedSearch in Google Scholar
  • 14 Gamboa-Bobadilla GM. Implant breast reconstruction using acellular dermal matrix. Ann Plast Surg 2006; 56: 22-5
    CrossrefPubMedSearch in Google Scholar
  • 15 Salzberg CA, Ashikari AY, Koch RM. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 2011; 127: 514-24
    CrossrefPubMedSearch in Google Scholar
  • 16 Basta MN, Gerety PA, Serletti JM. et al. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg 2015; 136: 1135-44
    CrossrefPubMedSearch in Google Scholar
  • 17 Lardi AM, Ho-Asjoe M, Mohanna PN. et al. Immediate breast reconstruction with acellular dermal matrix: factors affecting outcome. J Plast Reconstr Aesthet Surg 2014; 67: 1098-105
    CrossrefPubMedSearch in Google Scholar
  • 18 Gdalevitch P, Ho A, Genoway K. et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. Plast Reconstr Surg 2014; 133: 738e-747e
    CrossrefPubMedSearch in Google Scholar
  • 19 Roostaeian J, Sanchez I, Vardanian A. et al. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plast Reconstr Surg 2012; 129: 909e-918e
    CrossrefPubMedSearch in Google Scholar
  • 20 Susarla SM, Ganske I, Helliwell L. et al. Comparison of clinical outcomes and patient satisfaction in immediate singlestage versus two-stage implant-based breast reconstruction. Plast Reconstr Surg 2015; 135: 1e-8e
    CrossrefPubMedSearch in Google Scholar
  • 21 Negenborn VL, Dikmans REG, Bouman MB. et al. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg 2018; 105: 1305-12
    CrossrefPubMedSearch in Google Scholar
  • 22 Hunsicker LM, Ashikari AY, Berry C. et al. Short-term complications associated with acellular dermal matrix-assisted direct-to-implant breast reconstruction. Ann Plast Surg 2017; 78: 35-40
    CrossrefPubMedSearch in Google Scholar
  • 23 Petit JY, Veronesi U, Orecchia R. et al. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 2009; 117: 333-8
    CrossrefPubMedSearch in Google Scholar
  • 24 Algaithy ZK, Petit JY, Lohsiriwat V. et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis?. Eur J Surg Oncol 2012; 38: 125-9
    CrossrefPubMedSearch in Google Scholar
  • 25 Roh TS, Kim JY, Jung BK. et al. Comparison of outcomes between direct-to-implant breast reconstruction following nipple-sparing mastectomy through inframammary fold incision versus noninframammary fold incision. J Breast Cancer 2018; 21: 213-21
    CrossrefPubMedSearch in Google Scholar
  • 26 Salzberg CA, Ashikari AY, Berry C. et al. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 2016; 138: 329-37
    CrossrefPubMedSearch in Google Scholar
  • 27 Lohmander F, Lagergren J, Roy PG. Implant based breast reconstruction with acellular dermal matrix: safety data from an open-label, multicenter, randomized, controlled trial in the setting of breast cancer treatment. Ann Surg 2019; 269: 836-41
    CrossrefPubMedSearch in Google Scholar
  • 28 Colwell AS. Current strategies with 1-stage prosthetic breast reconstruction. Gland Surg 2015; 4: 111-5
    PubMedSearch in Google Scholar
  • 29 Spear SL, Sher SR, Al-Attar A. Focus on technique: supporting the soft-tissue envelope in breast reconstruction. Plast Reconstr Surg 2012; 130 (05) Suppl 2 89S-94S
    CrossrefPubMedSearch in Google Scholar