Plast Reconstr Surg. 2025 Oct 30. doi: 10.1097/PRS.0000000000012567. Online ahead of print.
ABSTRACT
BACKGROUND: Breast cancer is one of the most common cancers diagnosed worldwide, with an estimated 2.3 million new cases in 2020. Breast reconstruction following mastectomy is crucial for the physical and mental well-being of patients. Therefore, the nipple-skin-sparing mastectomy (NSSM) technique has become a highly preferred surgical treatment option for breast cancer in recent years. Breast implants are placed above or below the pectoralis major muscle in single-stage procedures. This study aimed to elaborate on the inferior pedicled dermal flap technique, present the results of single-stage breast reconstruction following NSSM, and compare postoperative outcomes with those previously reported.
METHODS: Between 2014 and 2023, 420 patients who underwent nipple-sparing mastectomy and prosthesis repair in our clinic were retrospectively evaluated. Among these patients, 129 patients who underwent one-stage repair using an inferior pedicled adipodermal flap were included in our study. Patients were analyzed in terms of topographic features, breast size, amount of breast tissue removed, history of chemotherapy and radiotherapy, magnitude and types of postoperative complications.
RESULTS: A total of 129 patients with a mean age of 47.07 years (SD:8,02) were included in the study. Following the exclusion of breasts in which the NSSM technique was not utilized, 215 breasts were analyzed for outcomes. Postoperative complications were observed in 58 breasts (26.9%). These were categorized as major (n = 17; 7.9%) or minor (n = 41; 19.1%). Significant complications included total NAC necrosis, pillar necrosis, and prosthesis exposure. Minor complications included partial NAC necrosis, distal necrosis of medial and lateral pillars, loss of NAC grafts, local infections, and early postoperative seroma formation. Specifically, complications were distributed as follows: 30 breasts with partial NAC necrosis, 26 with pillar necrosis, 14 with complete NAC necrosis, 5 with graft loss, 15 with localized infections, and 26 with early seromas. Statistical analysis demonstrated a significant association between increased sternal notch-to-nipple distance and overall complication rates (p = 0.0027). Similarly, a significant correlation was found between higher breast volume (as indicated by resected tissue weight) and both total (p = 0.0035) and major (p = 0.0092) complication rates.
CONCLUSIONS: A common complication of single-session NSSM and implant reconstruction is areolar skin necrosis; therefore, double-layer repair is recommended to protect the circulation of thin skin flaps post-mastectomy. Autologous muscle and an inferior pedicled adipodermal flap as the second layer under the skin flap can be considered a more reliable technique for ptotic breasts.
PMID:41172344 | DOI:10.1097/PRS.0000000000012567
