Direct-to-Implant versus Immediate Free Flap Reconstruction after Nipple-Sparing Mastectomy : A Propensity Score-Matched Analysis
Copyright © 2022 by the American Society of Plastic Surgeons..
BACKGROUND: Both direct-to-implant (DTI) and immediate free flap (FF) breast reconstruction following nipple-sparing mastectomy (NSM) have been described in the literature. However, there is a paucity of comparative studies between these two techniques. Furthermore, existing studies do not control for factors influencing ischemic complications.
METHODS: A retrospective review of all NSMs performed at a single institution between January of 2014 and January of 2020 was performed. Immediate FF reconstructions were propensity score matched using probit regression to identify a comparable DTI cohort based on mastectomy weight, smoking, age, and history of radiotherapy. Primary outcomes of interest were 30-day ischemic complications.
RESULTS: One hundred eight NSMs performed in 79 patients were included. Average age was 45.7 ± 10.5 years and mean body mass index was 27.1 ± 4.8 kg/m 2 . There were 54 breasts in both the DTI group and the immediate FF group. Median mastectomy weight in the DTI group was 508 g (interquartile range, 264 g) as compared with 473 g (interquartile range, 303 g) in the FF group ( P = 0.792). There was no significant difference in the rate of partial nipple-areola complex necrosis in the DTI and FF groups (5.6% versus 3.7%, respectively; P = 0.500) or mastectomy flap necrosis (5.6% versus 11.1%; P = 0.297). Both the DTI and FF groups had a total nipple-areola complex necrosis rate of 1.9% ( P = 0.752).
CONCLUSION: Both DTI and immediate FF reconstruction can be safely offered to patients undergoing NSM while providing the benefit of a single reconstructive procedure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:151 |
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| Enthalten in: |
Plastic and reconstructive surgery - 151(2023), 6 vom: 01. Juni, Seite 1137-1145 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abdou, Salma A [VerfasserIn] |
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Date Completed 26.05.2023 Date Revised 07.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/PRS.0000000000010094 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352399376 |
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| 500 | |a Date Revised 07.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 by the American Society of Plastic Surgeons. | ||
| 520 | |a BACKGROUND: Both direct-to-implant (DTI) and immediate free flap (FF) breast reconstruction following nipple-sparing mastectomy (NSM) have been described in the literature. However, there is a paucity of comparative studies between these two techniques. Furthermore, existing studies do not control for factors influencing ischemic complications | ||
| 520 | |a METHODS: A retrospective review of all NSMs performed at a single institution between January of 2014 and January of 2020 was performed. Immediate FF reconstructions were propensity score matched using probit regression to identify a comparable DTI cohort based on mastectomy weight, smoking, age, and history of radiotherapy. Primary outcomes of interest were 30-day ischemic complications | ||
| 520 | |a RESULTS: One hundred eight NSMs performed in 79 patients were included. Average age was 45.7 ± 10.5 years and mean body mass index was 27.1 ± 4.8 kg/m 2 . There were 54 breasts in both the DTI group and the immediate FF group. Median mastectomy weight in the DTI group was 508 g (interquartile range, 264 g) as compared with 473 g (interquartile range, 303 g) in the FF group ( P = 0.792). There was no significant difference in the rate of partial nipple-areola complex necrosis in the DTI and FF groups (5.6% versus 3.7%, respectively; P = 0.500) or mastectomy flap necrosis (5.6% versus 11.1%; P = 0.297). Both the DTI and FF groups had a total nipple-areola complex necrosis rate of 1.9% ( P = 0.752) | ||
| 520 | |a CONCLUSION: Both DTI and immediate FF reconstruction can be safely offered to patients undergoing NSM while providing the benefit of a single reconstructive procedure | ||
| 520 | |a CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Sharif-Askary, Banafsheh |e verfasserin |4 aut | |
| 700 | 1 | |a Perez-Alvarez, Idanis |e verfasserin |4 aut | |
| 700 | 1 | |a Lavin, Christopher V |e verfasserin |4 aut | |
| 700 | 1 | |a Bartholomew, Alex J |e verfasserin |4 aut | |
| 700 | 1 | |a Sosin, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Tousimis, Eleni |e verfasserin |4 aut | |
| 700 | 1 | |a Fan, Kenneth L |e verfasserin |4 aut | |
| 700 | 1 | |a Song, David H |e verfasserin |4 aut | |
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