Salvage of Implant-Based Breast Reconstruction in Nipple-Sparing Mastectomies With Autologous Flaps

Background: Implant-based breast reconstruction (IBR) after nipple-sparing mastectomies (NSM) can have complications that require explantation of a tissue expander or permanent prosthesis. When complications occur, preservation of the nipple-areola complex (NAC) remains critical to ensure aesthetic breast reconstruction. To date, there are minimal data on outcomes for patients experiencing unplanned explantations in IBR after NSM. Objectives: To evaluate final reconstructive outcomes for NSM patients who undergo IBR and have an unplanned explanation and to separately analyze the outcome of the NAC aesthetic subunit. Methods: We analyzed a prospectively maintained database of NSM patients undergoing IBR reconstruction at a single institution to identify patients who had complications resulting in unplanned explanation. Demographics, covariates, and reconstructive outcomes, including salvage with IBR or autologous flaps, were assessed Final outcomes of the NAC were also evaluated. Results: A total of 213 patients underwent 382 NSM with IBR with either direct-to-implant (DTI) or tissue expander/implant (TE/I) reconstructions. The complication rate was 15.2% (N = 58) and 33 (8.6%) unplanned explantations occurred: 23 (69.8%) of whom ultimately completed reconstruction with either IBR (30.4%) or autologous flaps (69.6%). NACs were preserved in 62.5% of breasts with unplanned explantations Only 8 NACs were lost in the entire cohort (2.1 %). Conclusions: Following unplanned explantations in IBR after NSM, salvage can be performed with either IBR or autologous flaps. However, the majority of salvage procedures in IBR after NSM will be with autologous flaps that bring in healthy soft tissue to restore location specific defects caused by complications. The NAC can ultimately be preserved as an aesthetic subunit in most patients despite the occurrence of initial complications.