Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2018; 45(06): 534-541
DOI: 10.5999/aps.2017.01725
Original Article

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: A review of patient satisfaction

Ciaran M Hurley
Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
,
Adrian McArdle
Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
,
Kenneth M Joyce
Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
,
Eoin O’Broin
Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
› Author AffiliationsThe data presented in this paper were presented at the Association of Surgeons in Training (ASiT) Conference, Liverpool, UK, March 19, 2016.
› Further Information
   Permissions and Reprints

Background Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy.

Methods All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy.

Results During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocialwell-being (77.7±3.2).

Conclusions Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.

Keywords

Breast - Surgery, plastic - Patient satisfaction - Reconstructive surgical procedures


Publication History

Received: 26 November 2017

Accepted: 02 October 2018

Article published online:
03 April 2022

© 2018. 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/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Warren Peled A, Foster RD, Stover AC. et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol 2012; 19: 3402-9
    CrossrefPubMedGoogle Scholar
  • 2 Carlson GW, Losken A, Moore B. et al. Results of immediate breast reconstruction after skin-sparing mastectomy. Ann Plast Surg 2001; 46: 222-8
    CrossrefPubMedGoogle Scholar
  • 3 Romics Jr L, Chew BK, Weiler-Mithoff E. et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 2012; 99: 799-806
    CrossrefPubMedGoogle Scholar
  • 4 Carlson GW, Bostwick 3rd J, Styblo TM. et al. Skin-sparing mastectomy: oncologic and reconstructive considerations. Ann Surg 1997; 225: 570-5
    CrossrefPubMedGoogle Scholar
  • 5 Zinzindohoue C, Bertrand P, Michel A. et al. A prospective study on skin-sparing mastectomy for immediate breast reconstruction with latissimus dorsi flap after neoadjuvant chemotherapy and radiotherapy in invasive breast carcinoma. Ann Surg Oncol 2016; 23: 2350-6
    CrossrefPubMedGoogle Scholar
  • 6 Davies K, Allan L, Roblin P. et al. Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction. Breast 2011; 20: 21-5
    CrossrefPubMedGoogle Scholar
  • 7 Gahm J, Hansson P, Brandberg Y. et al. Breast sensibility after bilateral risk-reducing mastectomy and immediate breast reconstruction: a prospective study. J Plast Reconstr Aesthet Surg 2013; 66: 1521-7
    CrossrefPubMedGoogle Scholar
  • 8 Craig ES, Walker ME, Salomon J. et al. Immediate nipple reconstruction utilizing the DIEP flap in areola-sparing mastectomy. Microsurgery 2013; 33: 125-9
    CrossrefPubMedGoogle Scholar
  • 9 Hong KY, Kim YE, Minn KW. et al. Immediate nipple reconstruction during implant-based breast reconstruction. Aesthetic Plast Surg 2017; 41: 793-9
    CrossrefPubMedGoogle Scholar
  • 10 Williams EH, Rosenberg LZ, Kolm P. et al. Immediate nipple reconstruction on a free TRAM flap breast reconstruction. Plast Reconstr Surg 2007; 120: 1115-24
    CrossrefPubMedGoogle Scholar
  • 11 Wellisch DK, Schain WS, Noone RB. et al. The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg 1987; 80: 699-704
    CrossrefPubMedGoogle Scholar
  • 12 Pusic AL, Klassen AF, Scott AM. et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 345-53
    CrossrefPubMedGoogle Scholar
  • 13 Toth BA, Forley BG, Calabria R. Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 1999; 104: 77-84
    CrossrefPubMedGoogle Scholar
  • 14 Taylor CW, Horgan K, Dodwell D. Oncological aspects of breast reconstruction. Breast 2005; 14: 118-30
    CrossrefPubMedGoogle Scholar
  • 15 Delay E, Mojallal A, Vasseur C. et al. Immediate nipple reconstruction during immediate autologous latissimus breast reconstruction. Plast Reconstr Surg 2006; 118: 1303-12
    CrossrefPubMedGoogle Scholar
  • 16 Kim HR, Lim JS, Kim SM. et al. One-stage nipple and breast reconstruction following areola-sparing mastectomy. Arch Plast Surg 2013; 40: 553-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Korn PT, Maia M, Chen MH. Immediate nipple reconstruction with autologous breast reconstruction following areola-sparing mastectomy: a marriage of aesthetics and oncologic principles. Plast Reconstr Surg 2014; 134(4 Suppl 1): 79-80
    CrossrefGoogle Scholar
  • 18 Hyza P, Streit L, Vesely J. et al. New technique of immediate nipple reconstruction during immediate autologous DIEP or MS-TRAM breast reconstruction. Ann Plast Surg 2015; 74: 645-51
    CrossrefPubMedGoogle Scholar
  • 19 Spear SL, Arias J. Long-term experience with nipple-areola tattooing. Ann Plast Surg 1995; 35: 232-6
    CrossrefPubMedGoogle Scholar
  • 20 Jalini L, Lund J, Kurup V. Nipple reconstruction using the C-V flap technique: long-term outcomes and patient satisfaction. World J Plast Surg 2017; 6: 68-73
    PubMedGoogle Scholar
  • 21 Galimberti V, Vicini E, Corso G. et al. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast 2017; 34 Suppl 1: S82-4
    CrossrefPubMedGoogle Scholar
  • 22 van Verschuer VM, Mureau MA, Gopie JP. et al. Patient satisfaction and nipple-areola sensitivity after bilateral prophylactic mastectomy and immediate implant breast reconstruction in a high breast cancer risk population: nipple-sparing mastectomy versus skin-sparing mastectomy. Ann Plast Surg 2016; 77: 145-52
    CrossrefPubMedGoogle Scholar
  • 23 Jabor MA, Shayani P, Collins Jr DR. et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002; 110: 457-63
    CrossrefPubMedGoogle Scholar
  • 24 Jeevan R, Cromwell D, Browne J. et al. National mastectomy and breast reconstruction audit 2011. Leeds: NHS Information Centre; 2011
  • 25 Sisti A, Grimaldi L, Tassinari J. et al. Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol 2016; 42: 441-65
    CrossrefPubMedGoogle Scholar