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Assessing Perioperative Complications and Cost of Breast Neurotization in Immediate Implant-Based Breast Reconstruction Following Nipple Sparing Mastectomy: A Matched-Paired Comparison
Carter Boyd, Kshipra Hemal, Thomas Sorenson, Chris Amro, Samantha Lu, Brooke Miller, Nolan Karp, Mihye Choi
Hansjorg Wyss Department of Plastic Surgery, NYU Langone, USA
Background: Recent reports suggest breast neurotization can help restore nipple sensation in patients undergoing implant-based breast reconstruction (IBBR) following nipple-sparing mastectomy (NSM). There is a dearth of information regarding the outcomes and cost accrued by neurotization of the nipple areola complex (NAC). The objective of this study is to determine perioperative complications of performing nipple neurotization in IBBR and analyzing the incremental cost of performing this procedure.
Methods: A retrospective chart review was performed of patients who underwent NSM with IBBR. Breasts undergoing neurotization of the NAC were compared to breasts that did not undergo neurotization using 2:1 propensity score matching on patient age, reconstruction type (DTI vs. TE) and patient BMI. Primary endpoints included 30-day complications and cost of materials. Statistical analysis included descriptive statistics, t-tests, and chi-square tests where applicable with a predetermined level of significance of p<0.05.
Results: A total of 41 patients (78 breasts) were included, of which 15 patients (26 breasts) were in the neurotized cohort and matched to 30 patients (52 breasts) in the non-neurotized cohort. The average follow-up period was 10 months, and significantly lower in neurotized group (p<0.001). Patients were on average 41 years old and had a median body mass index of 22 kg/m
2 (Table). Major complications occurred in 7 (9%) breasts while minor complications occurred in 16 (21%) of breasts. Rates of major (p=0.4) and minor (p=0.5) complications did not vary by neurotization. Cases of neurotization added a mean cost of $7839 per breast.
Conclusions: As breast neurotization introduces increased complexity from coordination with the oncologic surgeons, use of microsurgical instrumentation, and additional implantable devices, it is important to compare perioperative outcomes to standard breast reconstruction. As our institution begins to offer this new technique, we have identified no increased risk of perioperative complications with NAC neurotization.
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