Plastic & Reconstructive Surgery: June 2015 - Volume
135 - Issue 6 - p 954e–962e
doi: 10.1097/PRS.0000000000001283
Frederick, Michael J. et al
Background: An
increasing number of women are candidates for nipple preservation with
mastectomy. It is unclear how previous breast surgery impacts nipple-sparing
mastectomy and immediate breast reconstruction.
Methods: A single-institution
retrospective review was performed between June of 2007 and June of 2013.
Results: Four hundred forty-four patients underwent 775 immediate breast
reconstructions after nipple-sparing mastectomy. Of these, 160 patients and 187
reconstructions had previous breast surgery, including 154 lumpectomies, 27
breast augmentations, and six reduction mammaplasties. Two hundred eighty-four
patients with 588 reconstructions without previous breast surgery served as the
control group. The previous breast surgery patients were older (49.6 years
versus 45.8 years; p < 0.001) but otherwise had similar demographics.
Previous breast surgery reconstructions were more often unilateral,
therapeutic, and associated with preoperative radiotherapy (p < 0.001 for
each). Extension of breast scars was common with previous breast surgery,
whereas the inframammary incision was most frequent if no scars were present (p
< 0.001). Multivariate regression analysis showed that previous breast
surgery was not a significant risk factor for ischemic complications or nipple
loss. Subgroup analysis showed extension of prior irradiated incisions was
predictive of skin flap necrosis (OR, 9.518; p = 0.05). A higher number of
lumpectomy patients had preoperative radiotherapy (41 versus 11; p < 0.001),
and patients with breast augmentation had more single-stage reconstructions
(85.2 percent versus 62.9 percent; p = 0.02).
Conclusion: Nipple-sparing
mastectomy and immediate reconstruction can be performed in patients with prior
breast surgery with no significant increase in nipple loss or ischemic
complications.
