Download PDF
J Reconstr Microsurg Open 2016; 01(02): 092-095
DOI: 10.1055/s-0036-1588030
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stacked Microsurgical Autologous Flap Breast Reconstruction Is an Ideal Option after Unilateral Nipple-Sparing Mastectomy

Jordan D. Frey
1   Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York
,
Michael Alperovich
1   Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York
,
Christina Y. Ahn
1   Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York
,
Robert J. Allen
1   Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

25 May 2016

07 June 2016

Publication Date:
02 September 2016 (online)

   Permissions and Reprints

Abstract

Background Nipple-sparing mastectomy (NSM) allows for complete preservation of the nipple-areola complex and is increasing in popularity. Autologous options in NSM provide an aesthetic reconstruction in a single stage; however, donor tissue may be scarce in these patients. Stacked microsurgical breast reconstruction, especially in unilateral cases, is an attractive alternative in NSM that is yet to be described.

Methods Patients undergoing NSM with stacked autologous flap reconstruction were identified with demographics, intraoperative variables, and outcomes analyzed.

Results Six patients who underwent unilateral NSM with stacked autologous free flaps were identified. The average patient age was 50.17 years and body mass index was 21.67. Average follow-up was 28.62 months. Five (83.3%) patients underwent unilateral NSM and reconstruction for a therapeutic indication. The average mastectomy weight was 235.67 grams. All patients were reconstructed with stacked deep inferior epigastric perforator flaps. The average total flap weight was 397.33 grams. Anastomoses in five stacked flaps (83.3%) were performed in an anterograde/retrograde fashion to the internal mammary (IMA) vessels. In one (16.7%) stacked flap, the two flaps were anastomosed in series to the IMA. There were no major complications and three incidences of minor complications. There were no incidences of partial or complete flap loss. The average number of secondary procedures was 0.83 per patient.

Conclusion Stacked microsurgical autologous breast flaps provide an optimal reconstruction after NSM and may be considered the reconstruction of choice in patients undergoing unilateral NSM with inadequate donor site tissue for single-flap reconstruction.

Keywords

nipple-sparing mastectomy - autologous reconstruction - breast cancer
 

  • References

  • 1 De La Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol 2015; 22 (10) 3241-3249
    CrossrefPubMedGoogle Scholar
  • 2 Peled AW, Wang F, Foster RD , et al. Expanding the indications for total skin-sparing mastectomy: is it safe for patients with locally advanced disease?. Ann Surg Oncol 2016; 23 (1) 87-91
    CrossrefPubMedGoogle Scholar
  • 3 Seki T, Jinno H, Okabayashi K , et al. Comparison of oncological safety between nipple sparing mastectomy and total mastectomy using propensity score matching. Ann R Coll Surg Engl 2015; 97 (4) 291-297
    CrossrefPubMedGoogle Scholar
  • 4 Frey JD, Alperovich M, Kim JC , et al. Oncologic outcomes after nipple-sparing mastectomy: a single-institution experience. J Surg Oncol 2016; 113 (1) 8-11
    CrossrefPubMedGoogle Scholar
  • 5 Burdge EC, Yuen J, Hardee M , et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol 2013; 20 (10) 3294-3302
    CrossrefPubMedGoogle Scholar
  • 6 Coopey SB, Tang R, Lei L , et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol 2013; 20 (10) 3218-3222
    CrossrefPubMedGoogle Scholar
  • 7 Reish RG, Lin A, Phillips NA , et al. Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plast Reconstr Surg 2015; 135 (4) 959-966
    CrossrefPubMedGoogle Scholar
  • 8 Dent BL, Small K, Swistel A, Talmor M. Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment. Aesthet Surg J 2014; 34 (4) 560-570
    CrossrefPubMedGoogle Scholar
  • 9 Colwell AS, Tessler O, Lin AM , et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg 2014; 133 (3) 496-506
    CrossrefPubMedGoogle Scholar
  • 10 Carlson GW, Chu CK, Moyer HR, Duggal C, Losken A. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J 2014; 20 (1) 69-73
    CrossrefPubMedGoogle Scholar
  • 11 Matsen CB, Mehrara B, Eaton A , et al. Skin flap necrosis after mastectomy with reconstruction: a prospective study. Ann Surg Oncol 2016; 23 (1) 257-264
    PubMedGoogle Scholar
  • 12 Alperovich M, Choi M, Frey JD , et al. Nipple-sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications?. Plast Reconstr Surg 2014; 134 (2) 202e-206e
    CrossrefPubMedGoogle Scholar
  • 13 Lee KT, Mun GH. Comparison of one-stage vs two-stage prosthesis-based breast reconstruction: a systematic review and meta-analysis. Am J Surg 2015; (e-pub ahead of print). doi: 10.1016/j.amjsurg.2015.07.015
    PubMedGoogle Scholar
  • 14 Raghavan S, Peled AW, Hansen SL, Esserman LJ, Sbitany H. Approaches to microvascular breast reconstruction after total skin-sparing mastectomy: a comparison of techniques. Ann Plast Surg 2015; 74 (Suppl. 01) S46-S51
    CrossrefPubMedGoogle Scholar
  • 15 Tanna N, Broer PN, Weichman KE , et al. Microsurgical breast reconstruction for nipple-sparing mastectomy. Plast Reconstr Surg 2013; 131 (2) 139e-147e
    CrossrefPubMedGoogle Scholar
  • 16 Stalder MW, Lam J, Allen RJ, Sadeghi A. Using the retrograde internal mammary system for stacked perforator flap breast reconstruction: 71 breast reconstructions in 53 consecutive patients. Plast Reconstr Surg 2016; 137 (2) 265e-277e
    CrossrefPubMedGoogle Scholar
  • 17 Mayo JL, Allen RJ, Sadeghi A. Four-flap breast reconstruction: bilateral stacked DIEP and PAP flaps. Plast Reconstr Surg Glob Open 2015; 3 (5) e383
    CrossrefPubMedGoogle Scholar
  • 18 Murray A, Wasiak J, Rozen WM, Ferris S, Grinsell D. Stacked abdominal flap for unilateral breast reconstruction. J Reconstr Microsurg 2015; 31 (3) 179-186
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Blechman KM, Broer PN, Tanna N, Ireton JE, Ahn CY, Allen RJ. Stacked profunda artery perforator flaps for unilateral breast reconstruction: a case report. J Reconstr Microsurg 2013; 29 (9) 631-634
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 2011; 127 (3) 1093-1099
    CrossrefPubMedGoogle Scholar
  • 21 Freedman RA, Kouri EM, West DW , et al. Higher stage of disease is associated with bilateral mastectomy among patients with breast cancer: a population-based survey. Clin Breast Cancer 2016; 16 (2) 105-112
    CrossrefPubMedGoogle Scholar
  • 22 Hoskin TL, Hieken TJ, Degnim AC, Jakub JW, Jacobson SR, Boughey JC. Use of immediate breast reconstruction and choice for contralateral prophylactic mastectomy. Surgery 2016; 159 (4) 1199-1209
    CrossrefPubMedGoogle Scholar
  • 23 Angelos P, Bedrosian I, Euhus DM, Herrmann VM, Katz SJ, Pusic A. Contralateral prophylactic mastectomy: challenging considerations for the surgeon. Ann Surg Oncol 2015; 22 (10) 3208-3212
    CrossrefPubMedGoogle Scholar
  • 24 Grossman SG. The Angelina Jolie effect in Jewish law: prophylactic mastectomy and oophorectomy in BRCA carriers. Rambam Maimonides Med J 2015; 6 (4) e0037
    CrossrefPubMedGoogle Scholar
  • 25 Momoh AO, Cohen WA, Kidwell KM , et al. Breast reconstruction in patients with unilateral breast cancer who choose contralateral prophylactic mastectomy - an assessment of postoperative morbidity. Plast Reconstr Surg 2015; 136 (4, Suppl) 116-117
    PubMedGoogle Scholar