CC BY 4.0 · Arch Plast Surg 2021; 48(05): V2
DOI: 10.1055/s-0043-1777249
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Commentary: Direct-to-Implant Breast Reconstruction following Nipple-sparing Mastectomy: Predictive Factors of Adverse Surgical Outcomes in Asian Patients

Chun-Lin Su
1   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Jia-Ruei Yang
1   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Wen-Ling Kuo
2   Department of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
3   College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Shin-Cheh Chen
2   Department of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
3   College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
David Chon-Fok Cheong
1   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
3   College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Jung-Ju Huang
1   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
3   College of Medicine, Chang Gung University, Taoyuan, Taiwan
4   Center for Tissue Engineering, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Comment on:

Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patientsArch Plast Surg 2021; 48(05): 483-493
DOI: 10.5999/aps.2021.00374

    Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients

    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. 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. 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). Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.


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    No conflict of interest has been declared by the author(s).

    Address for correspondence

    Jung-Ju Huang, MD, FACS
    Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Linkou Chang Gung Memorial Hospital
    5, Fu-Hsing St., Kweishan, Taoyuan 33305
    Taiwan   

    Publication History

    Article published online:
    22 February 2024

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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