21. SAS—Subareolar Sealant: Reduces Minor Complications and Surgery for Necrosis in Prosthetic Reconstruction after Nipple-Sparing Mastectomy

OBJECTIVE: Nipple-sparing mastectomy (NSM) is aesthetically superior to skin-sparing only mastectomy or reconstructed nipples. However, NSM partially preserves nipple ducts which are remaining communications between the environment and breast pocket that can potentially allow bacteria transfer and compromise the prosthesis, particularly if in pre-pectoral placement. Previous methods to create a subareolar “barrier” to reduce through-duct bacteria penetration involve subpectoral implant placement, adjunct meshes or acellular dermal matrix (ADM), and external nipple adhesives. To further protect the implant from nipple-derived contamination, we propose: SAS—Subareolar Sealant. SAS involves the application of a synthetic sealant on the nipple undersurface prior to implant placement. METHODS: All patients who underwent immediate breast reconstruction after NSM with pre-pectoral TE or DTI by the senior author between April 2013 to January 2021 were included in this study. Patients were excluded if their surgical procedures involved mastopexy or local tissue flaps. This study was approved by the Spectrum Health Institutional Review Board. All breasts received adjunctive acellular dermal matrix. RESULTS: We analyzed 77 breasts that received prepectoral prosthetic breast reconstruction. SAS was used in 70 of 77 breasts. Comparing SAS vs No-SAS, we found that No-SAS was associated with 10.4-fold more infections (p = 0.032) and 17.3-fold more re-hospitalizations (p = 0.017). No-SAS also resulted in more “at least one major complication” (p < 0.001), capsular contracture (p < 0.001), and necrosis requiring surgery (p < 0.001). Due to the small No-SAS sample size, goodness of fit (QIC) criteria was applied. Erythema, all minor complications, dehiscence, and necrosis requiring surgery remained significant (all, p <0.0001). CONCLUSION: This innovative technique markedly reduces overall minor complications and necrosis requiring surgery. With a larger No-SAS sample size, SAS might also reduce infection and hospitalization rates. Nonetheless, SAS reduces complications and is cost-effective compared to other adjunct materials. CORRESPONDING AUTHOR: Elizabeth Bushong, 553 Union Ave. SE, Grand Rapids, MI. 49503, [email protected], (760) 285-4085