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2008 Annual Meeting Abstracts

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Nipple-Sparing Mastectomy and Immediate Reconstruction: Experience with 54 Consecutive Cases
Joseph J. Disa, MD, Constance M. Chen, MD, Babak J. Mehrara, MD, Andrea L. Pusic, MD, Virgilio Sacchini, MD, Colleen McCarthy, Peter G. Cordeiro, MD.
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Nipple-Sparing Mastectomy and Immediate Reconstruction: Experience with 54 Consecutive Cases
Joseph J. Disa, MD, Constance M. Chen, MD, MPH, Babak J. Mehrara, MD, Virgilio Sacchini, MD, Andrea L. Pusic, MD, , Colleen McCarthy, MD, Peter G. Cordeiro, MD
Background: Nipple sparing mastectomy is becoming increasingly popular. The aesthetic benefits of nipple areolar preservation are obvious. The purpose of this study was to evaluate our experience in 54 consecutive cases with respect to patient selection, incision placement, complications and outcome.
Methods: We analyzed data on 54 consecutive patients who underwent nipple- or areola-sparing mastectomy with breast reconstruction at a single tertiary-care cancer center. Patients underwent mastectomy for prophylaxis (n=23), treatment of breast cancer (n=14), or both (n=17). All patients were reconstructed with breast implants in either 1 stage (n=5) or 2 stages (n=49).
Results: Mean patient age was 45 years (range 24-61 years) and mean follow-up time was 24 months (range 2 weeks-79 months). There were 88 procedures (34 bilateral, 20 unilateral), including 84 nipple-sparing and 4 areola-sparing procedures. On pathologic review, 17 patients had invasive cancer; 17 patients had ductal carcinoma in situ (DCIS); 4 patients had lobular carcinoma in situ (LCIS); 1 patient had phyllodes tumor; and 15 patients were cancer-free. Four patients (4.5%) underwent nipple-sparing mastectomy and had positive margins requiring nipple areola complex excision: 3 patients had residual DCIS; and 1 had infiltrative lobular carcinoma. In an additional 4 patients, the nipple did not survive; in two of these patients, the nipple-areola complex was reconstructed with a skate flap and skin graft. 26% of patients had partial thickness loss of the nipple and/or areola. Breast reconstruction with implants was performed in all patients (n=54); Silicone implants were used in 72% and saline implants in 28% of patients. Alloderm was used in 15 patients. Incision placement was lateral (n=19), peri-areolar (n=17), inframammary (n=11), or trans-areolar (n=6). There was a higher incidence of excellent symmetry 59% in bilateral reconstructions compared to 40% in unilateral reconstructions. There were no local recurrences of breast cancer in this series.
Conclusion: Nipple sparing mastectomy and immediate reconstruction has the potential to yield excellent results in implant based breast reconstruction. Careful attention must be paid to preoperative breast size and degree of ptosis, incision placement, oncologic concerns and the skill of the surgeon performing the mastectomy.


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