Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies
Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2017-06, Vol.139 (6), p.1300-1310 |
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| creator | Frey, Jordan D. Choi, Mihye Salibian, Ara A. Karp, Nolan S. |
| description | Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy.
All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction.
A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups.
Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction.
Therapeutic, III. |
| doi_str_mv | 10.1097/PRS.0000000000003340 |
| format | Article |
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All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction.
A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups.
Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction.
Therapeutic, III.</description><identifier>ISSN: 0032-1052</identifier><identifier>EISSN: 1529-4242</identifier><identifier>DOI: 10.1097/PRS.0000000000003340</identifier><identifier>PMID: 28538548</identifier><language>eng</language><publisher>United States: by the American Society of Plastic Surgeons</publisher><subject>Adult ; Aged ; Breast Implants ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Cohort Studies ; Databases, Factual ; Disease-Free Survival ; Esthetics ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Logistic Models ; Mammaplasty - methods ; Mastectomy, Subcutaneous - methods ; Middle Aged ; Nipples ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Survival Analysis ; Tissue Expansion Devices ; Transplantation, Autologous - methods ; Treatment Outcome</subject><ispartof>Plastic and reconstructive surgery (1963), 2017-06, Vol.139 (6), p.1300-1310</ispartof><rights>by the American Society of Plastic Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4036-dba0fad496c460c50550f43999375801659ce59af977a2e6f06a5c07e62f81023</citedby><cites>FETCH-LOGICAL-c4036-dba0fad496c460c50550f43999375801659ce59af977a2e6f06a5c07e62f81023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28538548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frey, Jordan D.</creatorcontrib><creatorcontrib>Choi, Mihye</creatorcontrib><creatorcontrib>Salibian, Ara A.</creatorcontrib><creatorcontrib>Karp, Nolan S.</creatorcontrib><title>Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies</title><title>Plastic and reconstructive surgery (1963)</title><addtitle>Plast Reconstr Surg</addtitle><description>Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy.
All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction.
A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups.
Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction.
Therapeutic, III.</description><subject>Adult</subject><subject>Aged</subject><subject>Breast Implants</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Cohort Studies</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Esthetics</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Mammaplasty - methods</subject><subject>Mastectomy, Subcutaneous - methods</subject><subject>Middle Aged</subject><subject>Nipples</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Survival Analysis</subject><subject>Tissue Expansion Devices</subject><subject>Transplantation, Autologous - methods</subject><subject>Treatment Outcome</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUcluFDEQtRCITAJ_gJCPHNKhvHb7GEYhRMqCkuHccjzVGUN3u7HdGviQ_C_OBhG-lGt5r5ZHyDsGBwxM_fHr5dUBPHtCSHhBFkxxU0ku-UuyKEFeMVB8h-ym9B2A1UKr12SHN0o0SjYLcrsMw2SjT2GkoaMXc3ZhwES3Pm_oyqc0Iz36NdlxjXGfngwDrr3NWH5Tb8e8T0uGHs459OEmzIl-imhTppfowphynF32hdmP9LgkMka62tiRsjIvPffT1GN1ddd-vKFnBYcuh8FjekNedbZP-PbR7pFvn49Wyy_V6cXxyfLwtHIShK7W1xY6u5ZGO6nBKVAKOimMMaJWDTCtjENlbGfq2nLUHWirHNSoedcw4GKPfHjgnWL4OWPK7eCTw76shmWblhngshHAoZTKh1IXQ0oRu3aKfrDxd8ugvROkLYK0_wtSYO8fO8zX5XZ_QU8K_OPdhr7cJ_3o5y3GdoO2z5t7Pq2ErHjRDnTxqvuQ-AOd6JZd</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Frey, Jordan D.</creator><creator>Choi, Mihye</creator><creator>Salibian, Ara A.</creator><creator>Karp, Nolan S.</creator><general>by the American Society of Plastic Surgeons</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>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies</title><author>Frey, Jordan D. ; Choi, Mihye ; Salibian, Ara A. ; Karp, Nolan S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4036-dba0fad496c460c50550f43999375801659ce59af977a2e6f06a5c07e62f81023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Breast Implants</topic><topic>Breast Neoplasms - mortality</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Cohort Studies</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Esthetics</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Mammaplasty - methods</topic><topic>Mastectomy, Subcutaneous - methods</topic><topic>Middle Aged</topic><topic>Nipples</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Survival Analysis</topic><topic>Tissue Expansion Devices</topic><topic>Transplantation, Autologous - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frey, Jordan D.</creatorcontrib><creatorcontrib>Choi, Mihye</creatorcontrib><creatorcontrib>Salibian, Ara A.</creatorcontrib><creatorcontrib>Karp, Nolan S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frey, Jordan D.</au><au>Choi, Mihye</au><au>Salibian, Ara A.</au><au>Karp, Nolan S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>139</volume><issue>6</issue><spage>1300</spage><epage>1310</epage><pages>1300-1310</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy.
All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction.
A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups.
Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction.
Therapeutic, III.</abstract><cop>United States</cop><pub>by the American Society of Plastic Surgeons</pub><pmid>28538548</pmid><doi>10.1097/PRS.0000000000003340</doi><tpages>11</tpages></addata></record> |
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| identifier | ISSN: 0032-1052 |
| ispartof | Plastic and reconstructive surgery (1963), 2017-06, Vol.139 (6), p.1300-1310 |
| issn | 0032-1052 1529-4242 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete - AutoHoldings |
| subjects | Adult Aged Breast Implants Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - surgery Cohort Studies Databases, Factual Disease-Free Survival Esthetics Female Follow-Up Studies Graft Survival Humans Logistic Models Mammaplasty - methods Mastectomy, Subcutaneous - methods Middle Aged Nipples Predictive Value of Tests Retrospective Studies Risk Assessment Survival Analysis Tissue Expansion Devices Transplantation, Autologous - methods Treatment Outcome |
| title | Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies |
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