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The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure

BACKGROUND: Conservative mastectomy procedures, such as the nipple-sparing mastectomy (NSM), present appealing options for patients with small invasive or noninvasive malignancies and those needing prophylactic mastectomies. Despite outstanding postoperative cosmetic results, nipple–areola complex (...

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Autores principales: Martinez, Carlos A., Reis, Scott M., Boutros, Sean G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142480/
https://www.ncbi.nlm.nih.gov/pubmed/27975014
http://dx.doi.org/10.1097/GOX.0000000000001098
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author Martinez, Carlos A.
Reis, Scott M.
Boutros, Sean G.
author_facet Martinez, Carlos A.
Reis, Scott M.
Boutros, Sean G.
author_sort Martinez, Carlos A.
collection PubMed
description BACKGROUND: Conservative mastectomy procedures, such as the nipple-sparing mastectomy (NSM), present appealing options for patients with small invasive or noninvasive malignancies and those needing prophylactic mastectomies. Despite outstanding postoperative cosmetic results, nipple–areola complex (NAC) and mastectomy skin flap (MSF) survival remains a concern. We present our two-stage nipple–areola preserving (NAP) mastectomy, which aims to decrease the rate of NAC loss and MSF necrosis after conservative mastectomies. MATERIAL AND METHODS: Seventy patients who underwent NSM because of malignant and benign conditions were divided into 2 groups: those who underwent our two-stage NAP mastectomy were matched to the group of mastectomy patients without preservation techniques. Demographic data and postoperative results were retrospectively assessed. RESULTS: The NAP group comprised 45 flaps (24 patients), and the NSM group comprised 75 flaps (46 patients). None were actively smoking. The mean time between the delay of the flap and breast reconstruction was 17.6 days (range, of 10–35 days) in the NAP group. No signs of NAC vascular compromise were observed in the NAP group. Nipple necrosis rates were significantly greater (P = 0.0136) in the NSM group: 9 cases in the NSM group versus none within the NAP group. Two patients within the NAP group required nipple excision at the time of their mastectomies after biopsies performed at the time of the NAC delay were positive for malignancy or atypia. CONCLUSIONS: Vascular delay techniques favor the blood supply of a tissue after a surgical wound, effectively improving the survival of the NAC and MSF after nipple-sparing mastectomies.
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spelling pubmed-51424802016-12-14 The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure Martinez, Carlos A. Reis, Scott M. Boutros, Sean G. Plast Reconstr Surg Glob Open Original Article BACKGROUND: Conservative mastectomy procedures, such as the nipple-sparing mastectomy (NSM), present appealing options for patients with small invasive or noninvasive malignancies and those needing prophylactic mastectomies. Despite outstanding postoperative cosmetic results, nipple–areola complex (NAC) and mastectomy skin flap (MSF) survival remains a concern. We present our two-stage nipple–areola preserving (NAP) mastectomy, which aims to decrease the rate of NAC loss and MSF necrosis after conservative mastectomies. MATERIAL AND METHODS: Seventy patients who underwent NSM because of malignant and benign conditions were divided into 2 groups: those who underwent our two-stage NAP mastectomy were matched to the group of mastectomy patients without preservation techniques. Demographic data and postoperative results were retrospectively assessed. RESULTS: The NAP group comprised 45 flaps (24 patients), and the NSM group comprised 75 flaps (46 patients). None were actively smoking. The mean time between the delay of the flap and breast reconstruction was 17.6 days (range, of 10–35 days) in the NAP group. No signs of NAC vascular compromise were observed in the NAP group. Nipple necrosis rates were significantly greater (P = 0.0136) in the NSM group: 9 cases in the NSM group versus none within the NAP group. Two patients within the NAP group required nipple excision at the time of their mastectomies after biopsies performed at the time of the NAC delay were positive for malignancy or atypia. CONCLUSIONS: Vascular delay techniques favor the blood supply of a tissue after a surgical wound, effectively improving the survival of the NAC and MSF after nipple-sparing mastectomies. Wolters Kluwer Health 2016-11-23 /pmc/articles/PMC5142480/ /pubmed/27975014 http://dx.doi.org/10.1097/GOX.0000000000001098 Text en Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Martinez, Carlos A.
Reis, Scott M.
Boutros, Sean G.
The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title_full The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title_fullStr The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title_full_unstemmed The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title_short The Nipple–Areola Preserving Mastectomy: The Value of Adding a Delay Procedure
title_sort nipple–areola preserving mastectomy: the value of adding a delay procedure
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142480/
https://www.ncbi.nlm.nih.gov/pubmed/27975014
http://dx.doi.org/10.1097/GOX.0000000000001098
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