Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients
Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2021-09-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00374 |
| _version_ | 1811303054057668608 |
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| author | Chun-Lin Su Jia-Ruei Yang Wen-Ling Kuo Shin-Cheh Chen David Chon-Fok Cheong Jung-Ju Huang |
| author_facet | Chun-Lin Su Jia-Ruei Yang Wen-Ling Kuo Shin-Cheh Chen David Chon-Fok Cheong Jung-Ju Huang |
| author_sort | Chun-Lin Su |
| collection | DOAJ |
| description | Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.
Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.
Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025).
Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts. |
| first_indexed | 2024-04-13T07:39:51Z |
| format | Article |
| id | doaj.art-1b4d650a7aa44c33816dfe783352f96f |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-13T07:39:51Z |
| publishDate | 2021-09-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-1b4d650a7aa44c33816dfe783352f96f2022-12-22T02:55:55ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712021-09-01480548349310.5999/aps.2021.003743887Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patientsChun-Lin Su0Jia-Ruei Yang1Wen-Ling Kuo2Shin-Cheh Chen3David Chon-Fok Cheong4Jung-Ju Huang5Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, TaiwanDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, TaiwanDepartment of General Surgery, Linkou Chang Gung Memorial Hospital, TaoyuanDepartment of General Surgery, Linkou Chang Gung Memorial Hospital, TaoyuanDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, TaiwanDivision of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, TaiwanBackground Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes. Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed. Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025). Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00374mammaplastybreast implantmastectomytreatment outcomes |
| spellingShingle | Chun-Lin Su Jia-Ruei Yang Wen-Ling Kuo Shin-Cheh Chen David Chon-Fok Cheong Jung-Ju Huang Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients Archives of Plastic Surgery mammaplasty breast implant mastectomy treatment outcomes |
| title | Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients |
| title_full | Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients |
| title_fullStr | Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients |
| title_full_unstemmed | Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients |
| title_short | Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients |
| title_sort | direct to implant breast reconstruction following nipple sparing mastectomy predictive factors of adverse surgical outcomes in asian patients |
| topic | mammaplasty breast implant mastectomy treatment outcomes |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00374 |
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