E. M. Urrechaga1, A. Soran1,2, P. F. McAuliffe1,2,3, R. R. Johnson1,2, C. Thomas1,2, M. Bonaventura1,2, G. M. Ahrendt1,2, E. J. Diego1,2 3Magee-Womens Research Institute,Pittsburgh, PA, USA 1University Of Pittsburgh,Pittsburgh, PA, USA 2Magee-Womens Hospital Of UPMC,Pittsburgh, PA, USA
Introduction:
Nipple sparing mastectomy (NSM) has been proven to be oncologically safe with relatively low complication rates. With expanding indications for NSM, a larger population of patients (pts) is undergoing the procedure for therapeutic or prophylactic purposes. Though it has been established that obesity (Body Mass Index (BMI) >30) increases the risk for complications after NSM requiring reoperation, there is a paucity of data regarding this risk in patients with a low BMI (<18.5). We hypothesize that patients with a low BMI are at higher risk of clinically significant nipple and skin complications requiring a reoperation after NSM compared to patients with a normal BMI.
Methods:
A retrospective review of a prospectively maintained NSM registry was performed at a single institution from August 2010-June 2016. Clinicopathological information including age, cancer status and stage, BMI, bra cup size, smoking status, incision and reconstruction type, and need for chemo or radiation therapy were recorded. BMI was categorized into 3 groups: low (<18.5), normal-overweight (18.5-30), and obese (>30). Chart review was performed to evaluate need and reason for reoperation. Fisher’s exact test was performed to evaluate BMI and reoperation rates using STATA 14.1 with significance set at a p-value <0.05.
Results:
Of 211 pts who underwent 370 NSMs, 6.6% (14/211) had a low BMI, 88.2% (186/211) had normal to overweight BMI, and 5.2% (11/211) were obese (BMI>30). Of 370 NSMs, reoperation was required in 12.4% (46/370): 8.1% (30/370) for nipple/skin necrosis and 4.3% (16/370) for infection. Among pts with low BMI, 21.4% (3/14) required reoperation for either skin or nipple necrosis compared to 16.1% (30/186) in the normal BMI group and 27.3% (3/11) in the high BMI group (p=0.02). In the pts with low BMI, 2 pts suffered bilateral nipple loss. In the pts with high BMI, 1 pt had bilateral nipple loss.
Conclusion:
Pts with a low BMI are at higher risk for clinically significant skin or nipple necrosis that may require reoperation compared to those who have a normal BMI. These findings also confirmed a higher risk of skin or nipple necrosis requiring reoperation in the high BMI group. A larger sample would be needed to confirm these results, but this should be taken into consideration when counseling pts regarding surgical risk.
