Zhang Ashley, Salingaros Sophia, Wright Matthew A, Black Grant G, Otterburn David M
From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY.
Ann Plast Surg. 2025 Apr 1;94(4S Suppl 2):S283-S290. doi: 10.1097/SAP.0000000000004252.
Nipple-sparing mastectomy (NSMs) and the deep inferior epigastric perforator (DIEP) flap for breast reconstruction represent the latest evolutions of breast and reconstructive surgery, with resemblance to the aesthetics and feel of the natural breast without needing additional nipple reconstruction or tattooing. Despite clinical adoption of these advances, current literature of autologous reconstruction after NSM remains limited. Herein, we classify the incidence and predictors for the most common complications in patients undergoing NSM and DIEP flap reconstruction over a 10-year period.
This is a retrospective review of all patients receiving uni- or bilateral NSMs with DIEP flap breast reconstruction by the senior author between July 2013 and November 2022. Complications included flap issues, infection, hematoma, and wound healing problems within 90 days.
Two hundred fourteen patients had post-NSM DIEP reconstruction for 380 breasts. The average age at reconstruction was 49.98 (SD 10.0). Sixteen (4.2%) flaps required a reoperation during the same admission: 13 were due to a hematoma, 2 were due to flap thrombosis, and 1 was due to venous congestion. No flaps were lost. On multivariate analysis, body mass index > 25 kg/m2 and tobacco use were associated with breast and abdominal complications. Delayed-immediate reconstruction was protective against breast complications (odds ratio 0.16, P = 0.001).
In our series of 380 DIEP flaps after NSM, we present a major donor site complication rate of 5.9% and a major recipient site complication rate of 16.3%. Body mass index and tobacco use are associated with breast and abdominal complications. Delayed-immediate reconstruction has a protective effect on breast complications.
保留乳头的乳房切除术（NSM）和用于乳房重建的腹壁下深动脉穿支（DIEP）皮瓣代表了乳房和重建手术的最新进展，其在美学和触感上与天然乳房相似，无需额外的乳头重建或纹身。尽管这些进展已在临床上得到应用，但目前关于NSM后自体重建的文献仍然有限。在此，我们对10年间接受NSM和DIEP皮瓣重建的患者中最常见并发症的发生率和预测因素进行了分类。
这是一项对2013年7月至2022年11月期间由资深作者进行单侧或双侧NSM并采用DIEP皮瓣乳房重建的所有患者的回顾性研究。并发症包括皮瓣问题、感染、血肿以及90天内的伤口愈合问题。
214例患者接受了NSM后的DIEP重建，共涉及380个乳房。重建时的平均年龄为49.98岁（标准差10.0）。16个（4.2%）皮瓣在同一住院期间需要再次手术：13个是由于血肿，2个是由于皮瓣血栓形成，1个是由于静脉充血。没有皮瓣丢失。多因素分析显示，体重指数>25kg/m²和吸烟与乳房及腹部并发症相关。延迟即刻重建对乳房并发症具有保护作用（比值比0.16，P = 0.001）。
在我们这组380例NSM后的DIEP皮瓣病例中，我们呈现出供区主要并发症发生率为5.9%，受区主要并发症发生率为16.3%。体重指数和吸烟与乳房及腹部并发症相关。延迟即刻重建对乳房并发症有保护作用。
