Presenting Author:
Principal Investigator:
Department:
Surgery
Keywords:
breast reconstruction, nipple-sparing mastectomy, tissue expander, breast implant, implant shape
Location:
Ryan Family Atrium, Robert H. Lurie Medical Research Center
C138 - Clinical Women's Health Research
Nipple Position and Aesthetics with Expander-Implant Reconstruction
Background – Nipple positioning can be affected by a number of factors post nipple-sparing mastectomy (NSM), and the reconstructive surgeon must take into account all variables that may impact final nipple-areola complex (NAC) positioning and projection, including the type of permanent implant used. The NAC should be aligned with the level of maximal breast projection for optimal aesthetics. Yet, to date, there is no study present in the literature that analyzes the impact of implant type (shaped vs. round) on nipple displacement from the point of maximal projection in patients undergoing NSM with prosthetic reconstruction. Objectives – We endeavored to evaluate the changes to nipple position and aesthetic outcome with differing implant type in traditional expander implant reconstruction. Methods – A retrospective chart review was carried out on all patients who underwent NSM with immediate tissue expander breast reconstruction with the senior author (J.K.) from July 2008 through October 2016. Only patients who had completion of expander-implant exchange and photographic documentation of a post-exchange follow up of at least one month were included in the final analysis. Four blinded members of the Division of Plastic Surgery were asked to independently evaluate postoperative photographs for nipple position and aesthetic score. The panel graded photographs of these patients using a modified Likert scale. Scores ranging from 0 (poor) to 5 (excellent) were given for overall aesthetic result, upper pole contour, and natural appearance. Lateral photographs were then used to capture the displacement distance of the nipple from the point of maximal projection by measuring the angle between nipple position and the point of maximal projection. Results – Of 102 breasts (59 patients) meeting the inclusion criteria, 41 breasts (24 patients) had tissue expander-implant reconstruction with anatomical shaped implants, and 61 breasts (35 patients) had reconstruction with round implants. Age, BMI, ASA class, active smoking status, diabetes, prior radiation, post-mastectomy radiation, chemotherapy, and implant volume used for reconstruction were similar between both groups. The shaped implant cohort had less nipple deviation from the point of maximal projection (3.69±6.24 vs 7.52±10.50; P<.0001), as well as significantly higher aesthetic scores (4.04±0.67 vs 3.72±0.93; P=0.0044), than the round implant cohort. Subgroup delta analysis of 9 breasts (6 patients) with original post-exchange round implants that were later replaced for anatomically shaped implants further confirmed these findings. Conclusions – Quantitative analysis suggests that anatomic implants result in less nipple deviation from the point of maximum projection and improved aesthetic outcomes compared to round implants. Given the diverse options in prosthetic reconstruction, these findings can help better inform surgical decision-making and patient education.
