Donato Casella1, Claudio Calabrese1, Lorenzo Orzalesi1, Ilaria Gaggelli1, Lorenzo Cecconi2, Caterina Santi1, Roberto Murgo3, Stefano Rinaldi4, Lea Regolo5, Claudio Amanti6, Manuela Roncella7, Margherita Serra8, Graziano Meneghini9, Massimiliano Bortolini10, Vittorio Altomare11, Carlo Cabula12, Francesca Catalano13, Alfredo Cirilli14, Francesco Caruso15, Maria Grazia Lazzaretti16, Icro Meattini17, Lorenzo Livi17, Luigi Cataliotti18, Marco Bernini19. 1. Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy. 2. Statistics, Department of Statistics, Informatics and Application "G.Parenti", University of Florence, Viale Morgagni 59, 50134, Florence, Italy. 3. Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, 71013, S.Giovanni Rotondo, Foggia, Italy. 4. Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, 70123, Bari, Italy. 5. Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, 27100, Pavia, Italy. 6. Breast Unit Surgery, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy. 7. Breast Unit Surgery, Cisanello Hospital, Via Roma 67, 56123, Pisa, Italy. 8. Breast Unit Surgery, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy. 9. Breast Unit, Montecchio Maggiore Hospital, Via Ca' Rotte 7, 36075, Montecchio Maggiore, Vicenza, Italy. 10. Breast Unit Surgery, Valdese Hospital, Via Pellico 19, 10125, Turin, Italy. 11. Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy. 12. Breast Unit Surgery, Businco Hospital, Via Jenner 1, 09127, Cagliari, Italy. 13. Breast Unit, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy. 14. Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy. 15. Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, 95126, Catania, Italy. 16. Breast Unit Surgery, Ramazzini Hospital, Via Molinari 2, 41012, Carpi (Modena), Italy. 17. Radiation-Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy. 18. President European Breast Centres Certification, President Senonetwork Italia Onlus, Florence, Italy. 19. Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy. marco.bern@tin.it.
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.
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.
Entities:
Keywords:
Autologous breast reconstruction; Breast reconstruction; Direct-to-implant; Nipple-sparing mastectomy; Tissue expander
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