Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period

Donato Casella, Claudio Calabrese, Lorenzo Orzalesi, Ilaria Gaggelli, Lorenzo Cecconi, Caterina Santi, Roberto Murgo, Stefano Rinaldi, Lea Regolo, Claudio Amanti, Manuela Roncella, Margherita Serra, Graziano Meneghini, Massimiliano Bortolini, Vittorio Altomare, Carlo Cabula, Francesca Catalano, Alfredo Cirilli, Francesco Caruso, Maria Grazia LazzarettiIcro Meattini, Lorenzo Livi, Luigi Cataliotti, Marco Bernini

Research output: Contribution to journalArticle

Abstract

Background: Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study. Methods: Data extraction from the National Database was performed restricting cases to the 2009–2014 period. Different reconstruction procedures were analyzed in terms of their distribution over time and with respect to specific indications. A 1-year minimum follow-up was conducted to assess reconstructive unsuccessful events. Univariate and multivariate analyses were performed to investigate the causes of both prosthetic and autologous failures. Results: 913 patients, for a total of 1006 procedures, are included in the analysis. A prosthetic only reconstruction is accomplished in 92.2 % of cases, while pure autologous tissues are employed in 4.2 % and a hybrid (prosthetic plus autologous) in 3.6 %. Direct-to-implant (DTI) reaches 48.7 % of all reconstructions in the year 2014. Prophylactic NSMs have a DTI reconstruction in 35.6 % of cases and an autologous tissue flap in 12.9 % of cases. Failures are 2.7 % overall: 0 % in pure autologous flaps and 9.1 % in hybrid cases. Significant risk factors for failures are diabetes and the previous radiation therapy on the operated breast. Conclusions: Reconstruction following NSM is mostly prosthetic in Italy, with DTI gaining large acceptance over time. Failures are low and occurring in diabetic and irradiated patients at the multivariate analysis.

Original languageEnglish
Pages (from-to)451-457
Number of pages6
JournalBreast Cancer
DOIs
Publication statusPublished - May 2017

Keywords

  • Autologous breast reconstruction
  • Breast reconstruction
  • Direct-to-implant
  • Nipple-sparing mastectomy
  • Tissue expander

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Pharmacology (medical)

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    Casella, D., Calabrese, C., Orzalesi, L., Gaggelli, I., Cecconi, L., Santi, C., Murgo, R., Rinaldi, S., Regolo, L., Amanti, C., Roncella, M., Serra, M., Meneghini, G., Bortolini, M., Altomare, V., Cabula, C., Catalano, F., Cirilli, A., Caruso, F., ... Bernini, M. (2017). Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period. Breast Cancer, 451-457. https://doi.org/10.1007/s12282-016-0726-z