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“Breast in a Day”: Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy
Mihye Choi, MD, Jordan D. Frey, MD, Michael Alperovich, MD, Jamie P. Levine, MD, Nolan S. Karp, MD.
NYU Langone Medical Center, New York, NY, USA.

BACKGROUND: Nipple-sparing mastectomy (NSM) with immediate, permanent implant reconstruction offers patients a prosthetic “breast in a day” compared to tissue expander techniques requiring multiple procedures.
METHODS: Patients undergoing NSM with immediate, permanent implant reconstruction were reviewed with patient demographics and outcomes analyzed.
RESULTS: Of 842 NSMs from 2006 to June 2015, 160 (19.0%) underwent immediate, permanent implant reconstruction. The average age and body mass index were 46.5 years and 23.3, respectively. The majority of implants utilized were either Allergan Style 20 (48.1%) or Style 15 (22.5%). The average implant size was 376.2 milliliters (mL) and 91.3% of reconstructions utilized acellular dermal matrices (ADM). The average number of reconstructive operations was 1.3. Follow-up was 21.9 months. The most common major complication was major mastectomy flap necrosis (8.1%). The rate of reconstructive failure was 5.6% while that for implant loss was 4.4%. The most common minor complication was minor mastectomy flap necrosis (14.4%). The rates of full thickness and partial thickness nipple necrosis were 4.4% and 7.5%, respectively. Independent risk factors for complications were analyzed. Age greater than 50 (p=0.0276) and implant size greater than 400 mL (p=0.0467) emerged as independent predictors of overall complications. Obesity (p=0.4073), tobacco use (p=0.2749), prior radiation therapy (p=0.4613), and ADM (p=0.5305) were not associated with greater complication rates.
CONCLUSIONS: Immediate, permanent implant reconstruction in NSM provides patients with a “breast in a day” in less than two procedures with a low complication rate.

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