Enxerto do complexo aréolo-papilar em mastectomia: complicações, segurança oncológica e satisfação das pacientes

Abstract

The preservation of the nipple-areola complex (NAC) is fundamental, when possible, from the oncologic and anatomic point of view. However, in large and/or ptotic breasts it is challenging to preserve it, and the mastopexy with NAC graft is an alternative. There is few data in the literature about NAC grafting in patients undergoing mastectomy. The aim of this study was evaluate the complication and local recurrence rates, and the satisfaction with the NAC graft in patients undergoing mastectomy. Early (hematoma, necrosis, and infection) and late (dyschromia and nipple projection changes) local complications in 39 NAC grafts were evaluated. Oncologic safety was assessed using the ipsilateral local recurrence rate. Patient satisfaction was assessed by applying the postoperative Breast-Q breast reconstruction module and by specific questions regarding satisfaction with the NAC graft. Most NAC grafts (85%) did not present early complications. Of the 87% cases with late complications, fourteen (35%) were dyschromic and thirty-one cases (79%) had nipple projection changes. There were no cases of local recurrence in the graft. Regarding patient satisfaction, the highest scores in Breast-Q were in the domains of satisfaction with the overall result (85), followed by psychosocial well-being (78) and the lowest degree was in the sexual well-being domain (61). Regarding specific satisfaction with the NAC graft, the highest results were for satisfaction with nipple projection (90%) and areola size (90%) and the lowest was for sensitivity (65%). The NAC graft had a low rate of early complications and a high rate of late complications. It was safe from an oncological point of view and the patients showed high satisfaction and quality of life scores on Breast-Q and presented a high degree of satisfaction specific to the NAC graft.