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Immediate, Permanent Implant versus Tissue Expander Reconstruction in Nipple-Sparing Mastectomy: Fewer Operative Procedures but Greater Complication Rates?
Jordan D. Frey, MD, Michael Alperovich, MD, Jamie P. Levine, MD, Mihye Choi, MD, Nolan S. Karp, MD.
NYU Langone Medical Center, New York, NY, USA.

BACKGROUND: Optimal reconstruction techniques for NSM continue to be established; we thus aim to compare outcomes with permanent implant and tissue expander (TE)-based reconstruction.
METHODS: All patients undergoing NSM were reviewed and outcomes were compared between those who underwent permanent implant and TE-based reconstruction.
RESULTS: Of 842 NSMs, 160 and 447 underwent reconstruction with immediate, permanent implants and TEs, respectively. Age (p=0.8988), mastectomy indication (p=0.0991), and BMI (p=0.4313) were similar, however permanent implant reconstruction patients were significantly less likely to be current or former smokers (p=0.0176). They were more likely to have lateral inframammary fold and less likely to have lateral radial mastectomy incisions (p<0.0001). Permanent implant size was significantly greater compared to initial TE fill volumes (p<0.0001); permanent implant reconstruction patients had significantly more acellular dermal matrix coverage (p<0.0001). Permanent implant reconstruction patients had significantly fewer operative reconstructive procedures (p<0.0001) and shorter follow-up times (p<0.0001). Permanent implant reconstruction patients had significantly more full (p=0.0052) and partial thickness (p=0.0042) nipple-areola complex necrosis, explantation (p=0.0052), and minor mastectomy flap necrosis (p<0.0001) while TE-based reconstruction patients had significantly more cellulitis requiring oral antibiotics (p=0.0076). Other complications were similar between the groups.
CONCLUSIONS: Immediate, permanent implant-based reconstruction in NSM provides a breast with fewer operative procedures but greater rates of NAC necrosis, explantation, and mastectomy flap necrosis compared to TE-based reconstruction. This technique may still provide excellent results in appropriately selected patients.

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