Discussion: Oncologic Safety of Staged Prepectoral Implant Reconstruction following Nipple-Sparing Mastectomy: A Mean 9-Year Follow-Up

BACKGROUND:Prepectoral reconstruction following nipple-sparing mastectomy has recently gained popularity as an alternative to total or partial submuscular reconstruction. In the absence of long-term follow-up, concerns have been raised over the oncologic safety of using mastectomy flaps that preserve the entire thickness of the subcutaneous fat and its circulation. In this article, the authors present their average 9-year oncologic follow-up of patients who underwent nipple-sparing mastectomy and two-stage prepectoral implant reconstruction without acellular dermal matrix. METHODS:In this retrospective study, a group of previously reported (151 consecutive) breast cancer patients [246 breasts (160 therapeutic and 86 preventative)] who underwent nipple-sparing mastectomy and staged prepectoral implant reconstruction between 2005 and 2015 were followed up for an average of 109 months (range, 14 to 192 months). Tumor-related data, oncologic markers, staging, neoadjuvant/adjuvant therapy, and radiation therapy were evaluated to determine local recurrence, overall survival, and disease-free survival rates. RESULTS:The local recurrence rate in 151 patients was 2.6 percent. Eleven patients (7.3 percent) died as a result of metastatic disease and three patients died as a result of unrelated causes. The average 109-month overall survival rate was 92.9 percent, and the disease-free survival rate was 87.8 percent. Over the same period, nine patients (6 percent) were alive with distant disease. CONCLUSION:The authors' 9-year two-stage prepectoral reconstruction study of nipple-sparing mastectomy shows that the procedure is oncologically safe, having comparable recurrence, overall survival, and disease-free survival rates as total mastectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.