Optimizing aesthetic outcomes after Goldilocks mastectomy: A new method of nipple reconstruction.
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ABSTRACT:
SUBMITTER: Zingaretti N
PROVIDER: S-EPMC7700855 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
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Optimizing aesthetic outcomes after Goldilocks mastectomy: A new method of nipple reconstruction.
Zingaretti Nicola N Guarneri Gianni Franco GF Francesco Francesco De F Riccio Michele M Cordaro Emanuele Rampino ER Parodi Pier Camillo PC
Archives of plastic surgery 20201115 6
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Project description:BackgroundNipple-sparing mastectomy (NSM) followed by immediate breast reconstruction (IBR) is the optimal surgical treatment for breast cancer. However, investigations are ongoing to improve the surgical technique to achieve better results. This study aimed to evaluate the outcomes of modified NSM (m-NSM), which preserves the anterior lamellar fat layer, in patients who underwent IBR.MethodsAll patients who underwent modified NSM (m-NSM) or conventional NSM (c-NSM) followed by IBR using autologous tissue or implants were retrospectively reviewed between January 2014 and January 2021. Two mastectomy types were compared in terms of postoperative complications and aesthetic outcomes using panel assessment scores by physicians and reported outcomes using Breast-Q. In addition, postoperative evaluations of the thickness of mastectomy flap was performed using CT scan images.ResultsA total of 516 patients (580 breasts) with NSM (143 breasts with c-NSM and 437 breasts with m-NSM) followed by IBR were reviewed. The mean ± SD flap thickness was 8.48 ± 1.81 mm in patients who underwent m-NSM, while it was 6.32 ± 1.15 mm in the c-NSM cohort (p = 0.02). The overall major complications rate was lower in the m-NSM group (3.0% vs. 9.0%, p < 0.013). Ischemic complications of the mastectomy flap and nipple-areolar complex (NAC) were more in c-NSM, although the difference was not statistically significant. The mean panel assessment scores were higher in the m-NSM group (3.14 (good) and 2.38 (fair) in the m-NSM and c-NSM groups, respectively; p < 0.001). Moreover, m-NSM was associated with greater improvements in psychosocial (p < 0.001) and sexual (p = 0.007) well-being.ConclusionPreserving the anterior lamellar fat in NSM was associated with thicker mastectomy flap, overall lower rates of complications, including ischemia of the mastectomy flap and nipple-areolar complex, and was associated with better aesthetic outcomes and improved quality of life.
| S-EPMC9583667 | biostudies-literature
Project description:BackgroundThe current surgical methods for managing incisions after nipple excision in breast reconstruction patients are limited. However, double purse-string suture (DPS) shows promise in the treatment of nipple excision. This study aimed to investigate the safety and aesthetic outcomes of DPS nipple reconstruction in early breast cancer patients who underwent endoscopic skin-sparing mastectomy (E-SSM) and breast reconstruction.MethodsWe retrospectively analyzed the clinical data of 87 early breast cancer patients with nipple excision who underwent E-SSM with breast reconstruction. According to the suture methods of nipple incision, all patients were divided into the spindle suture (SS) group, single purse-string suture (SPS) group, and DPS group, with SS and SPS groups combined as the traditional suture (TS) group. Then, we compared the groups' differences in aesthetic outcomes, surgical safety, and oncological safety.ResultsA total of 87 patients with 88 breasts were enrolled in this study (SS n=17, SPS n=21, DPS n=50). Patients in the DPS group had significantly better nipple reconstruction satisfaction, Harris scale and any complications incidence than the TS group (all p <0.05). For nipple reconstruction satisfaction and any complication, the adjusted OR (95%CI) of the DPS group were 6.314(1.095-36.415) (p=0.039) and 0.124(0.018-0.863) (p=0.035) compared with the SS group. One patient in the SS group had vertebral metastases, and no recurrence, metastasis, or death has been observed in the other two groups during the follow-up period.ConclusionsDPS is an effective and safe nipple reconstruction procedure for patients undergoing E-SSM with breast reconstruction, delivering excellent aesthetic outcomes.
| S-EPMC11476627 | biostudies-literature
Project description:BackgroundThis study analyzes the aesthetic outcomes associated with inframammary fold (IMF) incisions compared to radial incisions, with or without a periareolar component (referred to as periareolar/radial, PR), considering nipple-sparing mastectomy (NSM) followed by prepectoral direct-to-implant (DTI) reconstruction and subsequent post-mastectomy radiotherapy (PMRT). We assessed changes in breast and nipple symmetry, nipple-to-IMF distance, and nipple Y-axis coefficients to understand how different incisions influence post-radiation aesthetic outcomes.MethodsForty patients who underwent NSM and prepectoral DTI reconstruction followed by PMRT between September 2019 and December 2022 in a single institution were included. Patients were divided into PR incision (n = 9) and IMF incision (n = 31) groups, with the latter further separated into IMF 1 group (surgeries from 2019 to 2021, n = 13) and IMF 2 group (surgeries in 2022, n = 18). Pre- and postoperative (6-18 months after surgery) analyses of body measurements and medical photographs were conducted using the Seoul Breast Esthetic Scoring Tool (S-BEST) software, developed by same institution, to calculate breast symmetry scores, nipple-to-IMF distance, and nipple Y-axis coefficients. Statistical analyses assessed differences between groups.ResultsAll groups showed decreased breast symmetry scores postoperatively (PR group: -1.111, IMF 1 group: -0.539, IMF 2 group: -0.389) and increased nipple-to-IMF distance (PR group: 0-0.2 cm, IMF 1 group: 0.2-0.5 cm, IMF 2 group: 0.3-0.4 cm). The changes in nipple y-axis coefficients were minimal across all groups. And the PR group received a lower average radiation dose (47.64 ± 5.2 Gy) than IMF 1 group (54.45 ± 5.28 Gy) and IMF 2 group (54.07 ± 4.79 Gy). Statistical analysis indicated no significant differences across the groups (p > 0.05, Kruskal-Wallis test).ConclusionsWhile IMF and PR incisions yielded similar aesthetic outcomes post-radiation, IMF incisions showed trends toward better symmetry, especially at higher radiation doses. These findings support the IMF incision as a favorable choice in NSM with DTI reconstruction followed by PMRT, though patient anatomy and preferences remain critical for surgical planning.
| S-EPMC11909819 | biostudies-literature
Project description:Nipple-areola complex (NAC) reconstruction in transgender and gender non-binary (TGNB) individuals undergoing chest wall masculinization surgery is critical for adequate satisfaction and aesthetic results. Here, we conducted a systematic review to find the various techniques and outcomes of NAC reconstruction in double-incision mastectomy and free nipple grafts (DIM-FNG). A comprehensive search of several databases was conducted based on PRISMA guidelines. We included studies that described the NAC reconstruction technique after DIM-FNG, and evaluated the surgical outcomes, or satisfaction, or aesthetic results after a minimum duration of follow-up of 6 months. Studies were assessed for risk of bias. A qualitative synthesis was performed. A total of 19 studies, comprising 1,587 patients (3,174 breasts), were included. There was a total of 14 studies using the conventional FNG technique, 4 describing new approaches for NAC reconstruction in FNG and 1 study comparing the conventional FNG technique to another alternative technique. A total of 1,347 patients underwent DIM-FNG with conventional FNG and 240 underwent alternative techniques for NAC reconstruction after DIM-FNG. Postoperative complications were low, and satisfaction was high for conventional and alternative techniques. Newer techniques aim to reshape the new NACs in an oval shape, reduce nipple size and place the NACs using the pectoralis major lateral and inferior borders as reference. In addition, a horizontal oval incision at the recipient site may avoid an undesired vertical NAC.
| S-EPMC8105810 | biostudies-literature
Project description:BackgroundSeveral studies reported the feasibility and safety of robotic-NSM (R-NSM). The aim of our prospective study was to compare R-NSM and conventional-NSM (C-NSM).MethodsWe analyzed patients who were operated on with and without robotic assistance (R-NSM or C-NSM) and who received immediate breast reconstruction (IBR) with implant or latissimus dorsi-flap (LDF). The main objective was complication rate and secondary aims were post-operative length of hospitalization (POLH), duration of surgery, and cost.ResultsWe analyzed 87 R-NSM and 142 C-NSM with implant-IBR in 50 and 135 patients, with LDF-IBR in 37 and 7 patients, respectively. Higher durations of surgery and costs were observed for R-NSM, without a difference in POLH and interval time to adjuvant therapy between R-NSM and C-NSM. In the multivariate analysis, R-NSM was not associated with a higher breast complication rate (OR=0.608) and significant factors were breast cup-size, LDF combined with implant-IBR, tobacco and inversed-T incision. Grade 2-3 breast complications rate were 13% for R-NSM and 17.3% for C-NSM, significantly higher for LDF combined with implant-IBR, areolar/radial incisions and BMI>=30. A predictive score was calculated (AUC=0.754). In logistic regression, patient's satisfaction between C-NSM and R-NSM were not significantly different, with unfavorable results for BMI >=25 (OR=2.139), NSM for recurrence (OR=5.371) and primary breast cancer with radiotherapy (OR=4.533). A predictive score was calculated. In conclusion, our study confirms the comparable clinical outcome between C- NSM and R-NSM, in the price of longer surgery and higher cost for R-NSM. Predictive scores of breast complications and satisfaction were significantly associated with factors known in the pre-operative period.
| S-EPMC7971115 | biostudies-literature
Project description:ObjectivesThe reasons for nipple malposition after nipple-sparing mastectomy with implant-based reconstruction are not well characterized, and nipple asymmetry remains a source of patient dissatisfaction. This study employed mathematical simulation to analyze the variables that affect nipple position, developed countermeasures to improve symmetry, and tested them in a case-control cohort.MethodsPatients who underwent nipple-sparing mastectomy followed by two-stage tissue expander and implant reconstruction were recruited and divided into two groups. The study group (N = 57) underwent reconstructive surgery guided by our mathematical simulations and countermeasures. The control group (N = 32) underwent reconstructive surgery using conventional methods.ResultsMorphological simulation revealed that the fundamental reason for nipple malposition is inadequate superior pole expansion. Thus, we developed a countermeasure: fixing the nipple areolar complex in a more inferior position, combined with inferior expander placement. Good or excellent symmetry was obtained in 45/57 (79%) patients in the study group and only 8/32 (25%) patients in the control group. In the control group, poorer results were associated with mastectomy weight (ρ = 0.47, P < 0.006), preoperative ptosis grade (ρ = 0.38, P = 0.037), and the difference between the superior pole length (B) and sub-mid-clavicle-to-inframammary fold length (l) (B-l; ρ = 0.067, P < 0.0001). In the study group, the results had no relation with those variables.ConclusionsMorphological simulation found that inadequate superior pole expansion is the primary reason for nipple malposition. On the basis of this result and the patient's breast measurements, we recommend fixing the nipple areolar complex in a more inferior position and possibly pulling the nipple inferiorly, combined with inferior expander placement.
| S-EPMC11913002 | biostudies-literature
Project description:Advances in breast cancer management have provided most patients with the hope for cure or avoidance of cancer altogether. Such advances have made quality of life much more important after treatment and have led to equally incredible advances in breast reconstruction, to the point where reconstructive goals have altered the way mastectomies are now performed. As experience and expertise in microsurgery has grown, the surgical feat of successfully transferring tissue to restore breast volume is no longer considered an adequate endpoint for aesthetic breast reconstruction. A shift towards patient-centered care has motivated plastic surgeons to adapt their approaches to reconstruction integrating aesthetic principles to the process of recreating a breast mound in order to provide patients with a long-term, natural, and optimal result. Vital to restoring a shapely breast is a thorough preoperative assessment and the understanding of the breast footprint, breast conus, skin envelope and nipple-areolar complex (NAC) position. These aesthetic goals should also extend to the donor site, where adequate contour improvement is sought to offset the price of the donor site scar and the morbidity is minimized. By utilizing strategies for optimizing the NAC position, incorporating novel techniques to ensure core projection, and paying attention to the donor site, the skilled microsurgeon can elevate breast reconstruction to the level of true aesthetic surgery where the reconstructed appearance is superior to the presurgical one.
| S-EPMC10493624 | biostudies-literature
Project description:BackgroundAlthough video-assisted breast surgery is gaining popularity, endoscopic reconstruction after mastectomy is still facing lots of problems, bring about that endoscopic method has not yet become a standard procedure for breast cancer reconstruction. Here, we introduce a novel surgical technique of video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction and describe the detailed surgical procedure using this technique.MethodsDetailed steps of surgical procedure, the patient characteristics and the mean operative time of this new technique were described in this article. All patients were asked to score their satisfaction with their reconstructed breasts preoperatively, 1 month, 3 months, 6 months and 12 months postoperatively using the BREAST-Q.ResultsAt first, we used our "conventional method" and performed on 10 patients from April 2017 to June 2020; the operative time was 324.80 ± 66.39 minutes. After improving several procedures of the technique, the "optimized method" was performed on 14 cases from July 2020 to November 2020; the operative time decreased to 193.71 ± 28.75 minutes with shortest was 133 minutes; the optimized method was novel and easy to learn and be generalized. Most of the patients were satisfied with the reconstruction results. There was no significant difference between preoperative scores and scores at 3 months, 6 months and 12 months (p = 0.364). Since there is no wound on the breast dome, no obvious postoperative complications were observed except for one patient presented with infection.ConclusionsThis new technique has allowed surgeons to achieve excellent and reproducible outcomes in a single-stage procedure and represents an excellent technique for patients who wish to have a scarless and aesthetically pleasing appearance after mastectomy for breast cancer. This article also highlights the mean operative time (193.71 ± 28.75 minutes) that has been made possible with this new technique.Level of evidence vThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
| S-EPMC8381859 | biostudies-literature
Project description:Background: Development of the nipple-sparing mastectomy (NSM) technique has dramatically improved breast reconstruction, and preservation of the nipple–areolar complex (NAC) positively influences patient satisfaction. However, women with large, ptotic breasts have historically not been candidates for NAC preservation due to impaired perfusion of the NAC leading to NAC loss. Although reduction mammoplasty has been reported as a strategy to increase candidacy for NSM, success rates and surgical outcomes for this staged approach are not well described in heterogeneous clinical scenarios. Methods: We performed a retrospective chart review of all patients who underwent reduction mammoplasty followed by NSM at our institution between January 2014 and September 2020. Clinical and surgical characteristics were collected. All surgical complications, including NAC loss rates, were analyzed. Results: Forty-one patients (74 breasts) underwent staged NSM during the defined time period. The average time between breast reduction mammoplasty and NSM was 213 days. Overall, 94.6% of NSM resulted in successful nipple preservation. There was no significant difference in the time interval from breast reduction mammoplasty to NSM between patients who had NAC loss (208 days) and those who did not (213 days, P = 0.87). Increasing age was significantly associated with risk of NAC loss (P = 0.002) in our cohort. Conclusions: In women with breast ptosis (which precludes safe NSM), it is possible to first offer reduction mammoplasty to preserve the NAC for future NSM. Our data suggest that 3 months between staged procedures is a safe time frame.
| S-EPMC9911193 | biostudies-literature
Project description:BackgroundMastectomy poses significant challenges to a woman's body image and psychological well-being, and breast reconstruction plays a pivotal role in postoperative quality of life. Following breast reconstruction, many patients choose to have subsequent aesthetic procedures. Data on the prevalence of such subsequent aesthetic interventions are lacking in the literature. The aim of this study was to analyze trends in aesthetic procedures in patients following mastectomy with and without breast reconstruction.MethodsThe PearlDiver database was queried within its capabilities for patients who underwent mastectomy with and without breast reconstruction, and a variety of aesthetic procedures after mastectomy. Aesthetic procedure rates were compared between cohorts.ResultsWe identified 365,525 mastectomy patients: 282,815 without reconstruction and 82,710 with reconstruction. In total, 609 patients with reconstruction and 329 without underwent subsequent aesthetic procedures. The rate of aesthetic procedures was higher in the reconstruction group (0.7%) compared with the nonreconstruction group (0.1%; P < 0.001).ConclusionsPatients who chose to have breast reconstruction after mastectomy underwent significantly more subsequent aesthetic procedures compared with those who chose mastectomy alone. Our findings provide insights on the prevalence of aesthetic procedures in postmastectomy patients, highlighting the potentially longitudinal nature of the reconstructive and aesthetic journey beyond the index oncologic procedure. Further research is needed to address motivations for such procedures as well as patient-reported outcomes and satisfaction.
| S-EPMC11221852 | biostudies-literature