Specific Objective: Nipple-sparing mastectomy (NSM) has become increasingly popular in recent years and enables immediate Direct-to-implant (DTI) reconstruction. Our objective was to review our experience of patients who had undergone NSM and DTI reconstruction and study the effects of the ‘learning curve’ for both services since the technique was introduced in our hospital.
Methods: Data from a retrospective chart review of a single plastic surgeon’s experience at a cancer center, from 2008 to 2015, was collected using a custom-designed REDCap database.
Results: 122 women underwent 202 immediate DTI breast reconstructions after NSM. During our study period, the number of procedures performed increased from one case in 2008, to 45 cases in 2014. There was a concomitant decrease in the number of revisions performed, from 100% to 25% in 2015. 15% patients required readmission for complications. The incidence of nipple and mastectomy flap necrosis, were 5% and 4% respectively. Of the 122 patients, 46.7% (59) of patients were satisfied with a single-stage reconstruction. 53.5% of patients (63) underwent further surgery to improve their reconstruction, upsizing being the commonest reason (36).
Conclusion: A single-stage direct-to-implant breast reconstruction following NSM allows the psychological benefit of ‘being done’, avoiding additional surgery. During this 8-year study period, there was a large increase in the number of NSM performed, with a dramatic decrease in revisions. A corresponding reduction in the number of complications was observed, as both resecting and reconstructive surgeons became more experienced. In our cohort, 47% of patients were satisfied with a single surgery.
