Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications
Background The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on co...
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| Veröffentlicht in: | Annals of surgical oncology 2019-10, Vol.26 (10), p.3115-3123 |
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| creator | Young, Whitney A. Degnim, Amy C. Hoskin, Tanya L. Jakub, James W. Nguyen, Minh-Doan Tran, Nho V. Harless, Christin A. Manrique, Oscar J. Boughey, Judy C. Hieken, Tina J. |
| description | Background
The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.
Methods
With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.
Results
We evaluated 1301 breasts in 769 women undergoing NSM for cancer (
n
= 555) or risk reduction (
n
= 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (
p
|
| doi_str_mv | 10.1245/s10434-019-07560-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22927583</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2263015694</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-54cd70f44cc1b55425dfce53b681e2d2ce3ccfaaa96a2d5387d171928ef3be153</originalsourceid><addsrcrecordid>eNp9kclO5DAQhi00iP0FOIwizTngNcsckEYtlpZYJJaz5XYc2qgTG9vRDJw4cOE1eRIqNMttTmWVv_pr-RHaJXiPUC72I8Gc8RyTOselKHD-uII2iIAULyryA964qPKaFmIdbcZ4hzEpGRZraJ0Rxikr8QZ6vhiSdp2JmWuzg9enF8Iwzs6t9wuTX3kVbH-bnamYjE6us8D9tWmeTbvONFYlk10a7fqYwqCTdf3v7Hpu4NcrnUbFw39e9c2oMYWg1chAqz6buM4vPhPbaLVVi2h2PuIWujk6vJ6c5KcXx9PJn9Ncc8xSLrhuStxyrjWZCcGpaFptBJvBtoY2VBumdauUqgtFG8GqsiElqWllWjYzcJgt9Gup62KyMmoLW81h_B6Wk5TWtBQV-6Z8cPeDiUneuSH0MBgwBcNEFDUHii4pHVyMwbTSB9up8CAJlqM9cmmPBHvkuz3yEYp-fkgPMzjgV8mnHwCwJRD9eHkTvnv_R_YNbBSdLg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2263015694</pqid></control><display><type>article</type><title>Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Young, Whitney A. ; Degnim, Amy C. ; Hoskin, Tanya L. ; Jakub, James W. ; Nguyen, Minh-Doan ; Tran, Nho V. ; Harless, Christin A. ; Manrique, Oscar J. ; Boughey, Judy C. ; Hieken, Tina J.</creator><creatorcontrib>Young, Whitney A. ; Degnim, Amy C. ; Hoskin, Tanya L. ; Jakub, James W. ; Nguyen, Minh-Doan ; Tran, Nho V. ; Harless, Christin A. ; Manrique, Oscar J. ; Boughey, Judy C. ; Hieken, Tina J.</creatorcontrib><description>Background
The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.
Methods
With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.
Results
We evaluated 1301 breasts in 769 women undergoing NSM for cancer (
n
= 555) or risk reduction (
n
= 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (
p
< 0.001), while the proportion of patients with obesity (
p
= 0.007) and treated with neoadjuvant chemotherapy (
p
< 0.001) increased. Prior radiation [odds ratio (OR) 2.35,
p
= 0.04], recent/current smoking (OR 3.37,
p
< 0.001), and body mass index (BMI) (OR 1.28 per 5-kg/m
2
increase,
p
= 0.03) significantly increased 30-day complication rates. Reconstruction success at 1 year was 96.7%. Prior radiation (OR 5.65,
p
< 0.001), axillary surgery (OR 2.55,
p
= 0.006), and postoperative adjuvant radiation (OR 3.22,
p
= 0.007) significantly affected 1-year reconstruction failure.
Conclusion
The 30-day complication rates of NSM decreased, despite broadened indications among higher-risk patients over time. These data confirm a team learning curve with NSM and also demonstrate that the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07560-z</identifier><identifier>PMID: 31342370</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Body mass index ; Breast cancer ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Breast Onology ; Breast surgery ; Cancer therapies ; CHEMOTHERAPY ; Female ; Follow-Up Studies ; HAZARDS ; Humans ; Mammaplasty - methods ; MAMMARY GLANDS ; Mastectomy ; Mastectomy - adverse effects ; Mastectomy - methods ; Medicine ; Medicine & Public Health ; METABOLIC DISEASES ; Middle Aged ; NEOPLASMS ; Nipples - surgery ; Obesity ; Oncology ; Organ Sparing Treatments - methods ; PATIENTS ; Postoperative Complications ; Prognosis ; Prospective Studies ; RADIOLOGY AND NUCLEAR MEDICINE ; Risk factors ; SMOKES ; Smoking ; SURGERY ; Surgical Oncology ; WOMEN ; Young Adult</subject><ispartof>Annals of surgical oncology, 2019-10, Vol.26 (10), p.3115-3123</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-54cd70f44cc1b55425dfce53b681e2d2ce3ccfaaa96a2d5387d171928ef3be153</citedby><cites>FETCH-LOGICAL-c403t-54cd70f44cc1b55425dfce53b681e2d2ce3ccfaaa96a2d5387d171928ef3be153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07560-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07560-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31342370$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22927583$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Young, Whitney A.</creatorcontrib><creatorcontrib>Degnim, Amy C.</creatorcontrib><creatorcontrib>Hoskin, Tanya L.</creatorcontrib><creatorcontrib>Jakub, James W.</creatorcontrib><creatorcontrib>Nguyen, Minh-Doan</creatorcontrib><creatorcontrib>Tran, Nho V.</creatorcontrib><creatorcontrib>Harless, Christin A.</creatorcontrib><creatorcontrib>Manrique, Oscar J.</creatorcontrib><creatorcontrib>Boughey, Judy C.</creatorcontrib><creatorcontrib>Hieken, Tina J.</creatorcontrib><title>Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.
Methods
With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.
Results
We evaluated 1301 breasts in 769 women undergoing NSM for cancer (
n
= 555) or risk reduction (
n
= 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (
p
< 0.001), while the proportion of patients with obesity (
p
= 0.007) and treated with neoadjuvant chemotherapy (
p
< 0.001) increased. Prior radiation [odds ratio (OR) 2.35,
p
= 0.04], recent/current smoking (OR 3.37,
p
< 0.001), and body mass index (BMI) (OR 1.28 per 5-kg/m
2
increase,
p
= 0.03) significantly increased 30-day complication rates. Reconstruction success at 1 year was 96.7%. Prior radiation (OR 5.65,
p
< 0.001), axillary surgery (OR 2.55,
p
= 0.006), and postoperative adjuvant radiation (OR 3.22,
p
= 0.007) significantly affected 1-year reconstruction failure.
Conclusion
The 30-day complication rates of NSM decreased, despite broadened indications among higher-risk patients over time. These data confirm a team learning curve with NSM and also demonstrate that the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment.</description><subject>Adult</subject><subject>Aged</subject><subject>Body mass index</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast Onology</subject><subject>Breast surgery</subject><subject>Cancer therapies</subject><subject>CHEMOTHERAPY</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>HAZARDS</subject><subject>Humans</subject><subject>Mammaplasty - methods</subject><subject>MAMMARY GLANDS</subject><subject>Mastectomy</subject><subject>Mastectomy - adverse effects</subject><subject>Mastectomy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>METABOLIC DISEASES</subject><subject>Middle Aged</subject><subject>NEOPLASMS</subject><subject>Nipples - surgery</subject><subject>Obesity</subject><subject>Oncology</subject><subject>Organ Sparing Treatments - methods</subject><subject>PATIENTS</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Risk factors</subject><subject>SMOKES</subject><subject>Smoking</subject><subject>SURGERY</subject><subject>Surgical Oncology</subject><subject>WOMEN</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kclO5DAQhi00iP0FOIwizTngNcsckEYtlpZYJJaz5XYc2qgTG9vRDJw4cOE1eRIqNMttTmWVv_pr-RHaJXiPUC72I8Gc8RyTOselKHD-uII2iIAULyryA964qPKaFmIdbcZ4hzEpGRZraJ0Rxikr8QZ6vhiSdp2JmWuzg9enF8Iwzs6t9wuTX3kVbH-bnamYjE6us8D9tWmeTbvONFYlk10a7fqYwqCTdf3v7Hpu4NcrnUbFw39e9c2oMYWg1chAqz6buM4vPhPbaLVVi2h2PuIWujk6vJ6c5KcXx9PJn9Ncc8xSLrhuStxyrjWZCcGpaFptBJvBtoY2VBumdauUqgtFG8GqsiElqWllWjYzcJgt9Gup62KyMmoLW81h_B6Wk5TWtBQV-6Z8cPeDiUneuSH0MBgwBcNEFDUHii4pHVyMwbTSB9up8CAJlqM9cmmPBHvkuz3yEYp-fkgPMzjgV8mnHwCwJRD9eHkTvnv_R_YNbBSdLg</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Young, Whitney A.</creator><creator>Degnim, Amy C.</creator><creator>Hoskin, Tanya L.</creator><creator>Jakub, James W.</creator><creator>Nguyen, Minh-Doan</creator><creator>Tran, Nho V.</creator><creator>Harless, Christin A.</creator><creator>Manrique, Oscar J.</creator><creator>Boughey, Judy C.</creator><creator>Hieken, Tina J.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>OTOTI</scope></search><sort><creationdate>20191001</creationdate><title>Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications</title><author>Young, Whitney A. ; Degnim, Amy C. ; Hoskin, Tanya L. ; Jakub, James W. ; Nguyen, Minh-Doan ; Tran, Nho V. ; Harless, Christin A. ; Manrique, Oscar J. ; Boughey, Judy C. ; Hieken, Tina J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-54cd70f44cc1b55425dfce53b681e2d2ce3ccfaaa96a2d5387d171928ef3be153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Body mass index</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast Onology</topic><topic>Breast surgery</topic><topic>Cancer therapies</topic><topic>CHEMOTHERAPY</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>HAZARDS</topic><topic>Humans</topic><topic>Mammaplasty - methods</topic><topic>MAMMARY GLANDS</topic><topic>Mastectomy</topic><topic>Mastectomy - adverse effects</topic><topic>Mastectomy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>METABOLIC DISEASES</topic><topic>Middle Aged</topic><topic>NEOPLASMS</topic><topic>Nipples - surgery</topic><topic>Obesity</topic><topic>Oncology</topic><topic>Organ Sparing Treatments - methods</topic><topic>PATIENTS</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Risk factors</topic><topic>SMOKES</topic><topic>Smoking</topic><topic>SURGERY</topic><topic>Surgical Oncology</topic><topic>WOMEN</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Young, Whitney A.</creatorcontrib><creatorcontrib>Degnim, Amy C.</creatorcontrib><creatorcontrib>Hoskin, Tanya L.</creatorcontrib><creatorcontrib>Jakub, James W.</creatorcontrib><creatorcontrib>Nguyen, Minh-Doan</creatorcontrib><creatorcontrib>Tran, Nho V.</creatorcontrib><creatorcontrib>Harless, Christin A.</creatorcontrib><creatorcontrib>Manrique, Oscar J.</creatorcontrib><creatorcontrib>Boughey, Judy C.</creatorcontrib><creatorcontrib>Hieken, Tina J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>OSTI.GOV</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Young, Whitney A.</au><au>Degnim, Amy C.</au><au>Hoskin, Tanya L.</au><au>Jakub, James W.</au><au>Nguyen, Minh-Doan</au><au>Tran, Nho V.</au><au>Harless, Christin A.</au><au>Manrique, Oscar J.</au><au>Boughey, Judy C.</au><au>Hieken, Tina J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>26</volume><issue>10</issue><spage>3115</spage><epage>3123</epage><pages>3115-3123</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>Background
The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.
Methods
With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.
Results
We evaluated 1301 breasts in 769 women undergoing NSM for cancer (
n
= 555) or risk reduction (
n
= 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (
p
< 0.001), while the proportion of patients with obesity (
p
= 0.007) and treated with neoadjuvant chemotherapy (
p
< 0.001) increased. Prior radiation [odds ratio (OR) 2.35,
p
= 0.04], recent/current smoking (OR 3.37,
p
< 0.001), and body mass index (BMI) (OR 1.28 per 5-kg/m
2
increase,
p
= 0.03) significantly increased 30-day complication rates. Reconstruction success at 1 year was 96.7%. Prior radiation (OR 5.65,
p
< 0.001), axillary surgery (OR 2.55,
p
= 0.006), and postoperative adjuvant radiation (OR 3.22,
p
= 0.007) significantly affected 1-year reconstruction failure.
Conclusion
The 30-day complication rates of NSM decreased, despite broadened indications among higher-risk patients over time. These data confirm a team learning curve with NSM and also demonstrate that the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31342370</pmid><doi>10.1245/s10434-019-07560-z</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2019-10, Vol.26 (10), p.3115-3123 |
| issn | 1068-9265 1534-4681 1534-4681 |
| language | eng |
| recordid | cdi_osti_scitechconnect_22927583 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Body mass index Breast cancer Breast Neoplasms - pathology Breast Neoplasms - surgery Breast Onology Breast surgery Cancer therapies CHEMOTHERAPY Female Follow-Up Studies HAZARDS Humans Mammaplasty - methods MAMMARY GLANDS Mastectomy Mastectomy - adverse effects Mastectomy - methods Medicine Medicine & Public Health METABOLIC DISEASES Middle Aged NEOPLASMS Nipples - surgery Obesity Oncology Organ Sparing Treatments - methods PATIENTS Postoperative Complications Prognosis Prospective Studies RADIOLOGY AND NUCLEAR MEDICINE Risk factors SMOKES Smoking SURGERY Surgical Oncology WOMEN Young Adult |
| title | Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications |
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