Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: Aesthetic outcomes and mitigating nipple-areolar complex necrosis.
- Author:
Wan Sze PEK
1
;
Bien Keem TAN
;
Yvonne Ying RU NG
;
Veronique KIAK MIEN TAN
;
Mohamed Zulfikar RASHEED
;
Benita KIAT TEE TAN
;
Kong Wee ONG
;
Yee Siang ONG
Author Information
- Publication Type:Original Article
- Keywords: Mastectomy; Nipples; Necrosis; Surgical flaps
- MeSH: Asian Continental Ancestry Group*; Breast Neoplasms; Breast*; Cicatrix; Female; Hospitals, General; Humans; Mammaplasty*; Mastectomy*; Necrosis*; Nipples; Patient Satisfaction; Risk Reduction Behavior; Sensation; Singapore; Skin; Surgical Flaps
- From:Archives of Plastic Surgery 2018;45(3):229-238
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. METHODS: All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. RESULTS: A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P < 0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. CONCLUSIONS: Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.
