November 2019 #PRSJournalClub Wrap-Up: Does Staged Breast Reduction before Nipple-Sparing Mastectomy Decrease Complications? A Matched Cohort Study between Staged and Nonstaged Techniques

by Íris M. Brito, MD
Plastic Surgery Resident
Coimbra University Hospital Center, Portugal


The November 2019 edition of #PRSJournalClub provided a significant contribution to the nipple-sparing mastectomy literature and an outstanding discussion on how to reduce complications in patients with large ptotic breasts, based on the PRS article entitled “Does Staged Breast Reduction before Nipple-Sparing Mastectomy Decrease Complications? A Matched Cohort Study between Staged and Nonstaged Techniques” by Salibian, Frey, Karp and Choi. The article can be read here.

In this study, the authors discuss whether staged breast reduction before prophylactic nipple-sparing mastectomy can reduce complications in the challenging population of patients with large and ptotic breasts. As indications for nipple-sparing mastectomy expand, plastic surgeons must more frequently determine appropriate candidates for nipple-sparing mastectomy based on relative reconstructive/breast morphology contraindications instead of absolute oncologic ones. Staged breast reduction before nipple-sparing mastectomy has been used as a means of reducing the skin envelope, repositioning the nipple-areola complex, and serving as a vascular delay for the nipple-areola complex and mastectomy flaps. In this paper, a direct comparison of outcomes between staged and nonstaged nipple-sparing mastectomy cases matched according to known risk factors for complications was performed. The authors found that the staged cohort had significantly lower rates of major mastectomy flap necrosis compared to nonstaged cases. In addition, rates of minor mastectomy flap necrosis, partial nipple necrosis, and explantation trended lower in the staged cohort. These are important findings since staged breast reduction before nipple-sparing mastectomy appears to decrease the risk of ischemic complications compared with nonstaged cases and may therefore serve as a useful modification of traditional immediate reconstruction techniques.

The article was first discussed by the current Resident Ambassadors to the PRS Editorial Board Lily Mundy, MD, Raj Parikh, MD, and Kyle Sanniec, MD—and the special guest Michael Neumeister, MD. Listen to the podcast discussion below:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (November 9-10), where established plastic surgeons and residents were able to ask questions, and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided here.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!

Sincerely,
Íris

This November #PRSJournalClub article (as well as other Journal Club selections from November), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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