Clinical feature and patient-report outcome of nipple-sparing mastectomy with immediate breast reconstruction: a eighteen-year cohort study

Clinical feature and patient-report outcome of nipple-sparing mastectomy with immediate breast reconstruction: a eighteen-year cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical feature and patient-report outcome of nipple-sparing mastectomy with immediate breast reconstruction: a eighteen-year cohort study Bowen Ding, Jie Wang, Shanshan He, Qingfeng Huang, Jian Yin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5276211/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Nipple-sparing mastectomy (NSM) has become increasingly common for breast cancer patients in China. There are limited data on its long-term clinical oncology and patient satisfaction. The objective of this study was to confirm the safety of clinical oncology and evaluate patient satisfaction with nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR). Methods We retrospectively analyzed the clinical data of patients who underwent NSM followed by immediate breast reconstruction in our department. Clinicopathological data and follow-up information were collected and analyzed to evaluate the safety of NSM with immediate breast reconstruction. The BREAST-Q questionnaire was used to assess patient-reported outcomes. Results A total of 610 patients, including 624 with reconstructed breasts, were included in the study. Our results revealed that factors such as age > 42 years, BMI > 24 kg/m2, periareolar incisions, reconstruction with implants and acellular dermal matrix (ADM) with or without serratus anterior were independent risk factors for short-term complications after NSM with IBR. We utilized a column chart and calibration curve to illustrate the factors affecting the occurrence of short-term postoperative complications. The overall survival (OS) of all patients was 98.7%, and nipple‒areolar complex (NAC) recurrence did not impair patient survival. The 10-year survival rate and distant metastasis-free survival (DMFS) rate of the 4 patients who experienced NAC recurrence were 100%. The 10-year OS for patients without NAC recurrence was 96.0% (p > 0.05), and the DMFS rate was 89.4% (p > 0.05). Most patients were satisfied with the aesthetic outcome (> 90%), and nipple sensation was reported in 41.0% of patients, 8.3% of whom had normal sensation. Conclusion NSM with immediate breast reconstruction yields favorable aesthetic outcomes, high patient satisfaction, and reliable oncological safety. Health sciences/Oncology/Cancer Health sciences/Oncology/Surgical oncology Health sciences/Oncology breast cancer nipple-sparing mastectomy immediate breast reconstruction patient-reported outcome measures Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Introduction The evolution of breast surgery, from radical mastectomy and skin-sparing mastectomy to nipple-sparing mastectomy (NSM), has improved postoperative aesthetic outcomes and patient satisfaction substantially; moreover, all of these methods maintain oncological safety [ 1 , 2 ]. Despite the increasing risk of local recurrence, preserving the nipple‒areola complex (NAC) still has the same oncological safety as other breast surgeries do [ 3 ]. The treatment objective for breast cancer has shifted from simply improving patient survival to emphasizing postoperative quality of life and aesthetic outcomes. Clinicians are concerned about minimizing surgical complications, and there is a need to evaluate patient satisfaction after NSM combined with breast reconstruction in China. We conducted a comprehensive analysis of patient demographics, tumor characteristics, and surgical factors to identify the key contributors to short-term complications. Additionally, we developed and validated a predictive model utilizing a line chart to assess the risk of short-term postoperative complications. Furthermore, we examined the risk factors associated with NAC necrosis in patients who underwent NSM in conjunction with breast reconstruction. We also assessed patient-reported outcomes and ensured the oncological safety of this surgical approach. The subsequent sections detail our findings. Methods 1. Patient characteristics We conducted a retrospective analysis of clinical data from 635 female patients who underwent nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction at our department between June 2005 and August 2022. Eighteen patients were excluded because they underwent NSM for non-breast malignancies, and 7 patients who underwent subcutaneous glandular tissue preservation surgery for ductal carcinoma in situ of the breast were also excluded. The final study cohort consisted of 610 patients, including 14 who underwent bilateral NSM (Fig. 1 ). The patients ranged in age from 21–70 years, with a mean age of 41.0 ± 7.8 years. Their body mass index (BMI) ranged from 16.02 to 34.17 kg/m2, with a mean BMI of 22.90 ± 2.78 kg/m2. All patients provided signed informed consent forms prior to surgery. All the clinical data related in this study were approved by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (EK20240412). This study was performed in accordance with the principles of the Declaration of Helsinki. 2. Research methods The study's inclusion criteria were as follows: (1) NSM followed by immediate breast reconstruction conducted within the breast reconstruction department; (2) confirmed breast malignancy through preoperative biopsy; and (3) absence of NAC involvement in both clinical and imaging examinations, including ultrasound, mammography, and magnetic resonance imaging, with negative pathological results for the NAC base margins. The exclusion criteria included the following: (1) a negative pathological outcome in frozen sections of the NAC base margins, combined with the detection of residual cancer cells in paraffin-embedded sections; (2) surgical pathology confirmation of benign breast disease; (3) prophylactic mastectomy; (4) subcutaneous glandular tissue resection surgery for various reasons; and (5) significant and irreversible loss of clinical data. All patients underwent pathological examination of the nipple‒areola complex in conjunction with intraoperative frozen pathological assessment. In cases where residual cancer tissue was identified in the nipple base tissue, a subsequent surgical intervention was undertaken to excise the nipple or NAC. We conducted a comprehensive follow-up study by thoroughly examining patient medical records, outpatient visits, and telephone communications. The follow-up period lasted until November 2022, with an average duration of 50.56 ± 40.28 months (ranging from 12 to 204 months). The clinical information gathered from patients included various aspects, such as age at diagnosis, BMI, smoking history, prior history of breast surgery, surgical duration, surgical side, incision type, axillary lymph node dissection, type of breast reconstruction, postoperative adjuvant treatment, and postoperative complications. Short-term breast complications were defined as those that occurred within three months of the initial surgery. NAC ischemic necrosis specifically refers to any ischemic condition affecting the nipple‒areola complex that requires local wound care. Patient satisfaction was assessed via the BREAST-Q questionnaire. Additionally, patients were rigorously monitored for any sign of recurrence, metastasis, or survival. The time interval of recurrence or metastasis was determined from the surgery date to the occurrence of the respective event. Our primary endpoints of interest include total complications, nipple-areolar necrosis, nipple-areola complex (NCR) recurrence, local recurrence (LR), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Our secondary endpoint was patient-reported outcomes. DMFS was defined as the time interval from the surgical procedure to the initial occurrence of distant metastasis. OS was defined as the period from surgery to the date of death. The LR, which does not include the NCR, encompasses cancer metastasis to the ipsilateral skin, chest wall, axilla, and supraclavicular lymph nodes. Nipple satisfaction was categorized into 4 levels: 1 = very dissatisfied, 2 = somewhat dissatisfied, 3 = somewhat satisfied, and 4 = very satisfied. Similarly, nipple or breast skin sensation was classified into 4 levels: 1 = no sensation, 2 = slight sensation, 3 = partial sensation, and 4 = normal sensation. Statistical analyses were performed via SPSS 24.0 and R software (version 4.2.2). Chi-square tests, analysis of variance (ANOVA), and Fisher's exact probability tests were employed to compare clinical characteristics. The classification threshold for continuous variables was determined via the receiver operating characteristic (ROC) curve. Univariate analysis was utilized to identify potential risk factors associated with short-term complications following breast surgery. Variables found to be significant in the univariate analysis were subsequently included in a multivariate logistic regression analysis. A predictive model was developed for short-term postbreast surgery complications through regression analysis via R software. The model's predictive accuracy was assessed via the concordance index (C-index) and calibration curve, with the line chart model created via the "rms" and "rmda" packages. Furthermore, both univariate and multivariate logistic regression models were utilized to examine potential risk factors for nipple‒areola complex (NAC) necrosis following nipple‒sparing mastectomy (NSM) in conjunction with breast reconstruction. We used multivariate ordinal logistic regression analysis to determine the factors impacting patient satisfaction. The Kaplan–Meier method was used to analyze survival, and the log-rank test was used to statistically evaluate differences in survival. A two-tailed p value threshold of 0.05 was used to assess statistical significance. Results 1. Surgical outcomes In this study, NSM incisions comprised inframammary fold (IMF) incisions in 16.7% (104/624) of the cases; tumor surface incisions (including radial, arc-shaped, spindle-shaped, or circular incisions on the tumor surface) in 63.6% (397/624) of the patients; periareolar incisions in 14.7% (92/624) (including periareolar ± extended lateral or medial incisions and omega incisions); and other incisions (including axillary or other nonbreast surface incisions) in 5.0% (31/624). Breast reconstruction methods included implant + ADM ± serratus anterior in 38.5% (240/624) of patients, implant ± serratus anterior in 13.3% (83/624), implant + latissimus dorsi in 21.2% (132/624), autologous reconstruction in 27.1% (169/624) (encompassing transverse rectus abdominis musculocutaneous flap (TRAM), deep inferior epigastric perforator flap (DIEP), and latissimus dorsi ([LD] flap), implant ± serratus anterior in 13.3% (83/624), and implant + latissimus dorsi in 21.2% (132/624). Both one-stage and two-stage breast reconstructions using breast prostheses were categorized as implant-based reconstructions in this study (Table 1). Table 1. Clinicopathological features of patients Clinicopathological features Number (%) Age (n=610) ≤42 years old 341 (55.9) >42 years old 269 (44.1) BMI (n=610) ≤24 kg/m 2 434 (71.1) >24 kg/m 2 176 (28.9) Sides (n=610) Left side 273 (44.7) Right side 323 (53.0) Bilateral 14 (2.3) Stage (n=610) 0-I 257(42.1) II-III 353(57.9) HER-2 Status (n=610) HER-2(-) 466(76.4) HER-2(+) 144(23.6) HR Status(n=610) HR<1% 137(22.5) HR≥1% 473(77.5) Breast reconstruction techniques (n=624) Prosthesis + patch ± serratus anterior muscle 240 (38.5) Autologous flap (TRAM/DIEP/latissimus dorsi) 169 (27.1) Prosthesis ± serratus anterior muscle 83 (13.3) Prosthesis + LD 132 (21.2) Incision types (n=624) Inframammary fold incision 104 (16.7) Tumor surface incision 397 (63.6) Areola incision 92 (14.7) Others (axilla/other nonbreast surface incisions) 31 (5.0) 2. Complications and Factors Affecting Breast Reconstruction following NSM The short-term complication rate following NSM combined with breast reconstruction was 19.7% (123/624). The complications included nipple‒areolar complex (NAC) necrosis, breast infection, breast flap necrosis, incision nonhealing or dehiscence, hemorrhage, fat necrosis, seroma, and hematoma. Among patients who experienced short-term problems, 25.20% (31/123) underwent surgery, while the others were treated conservatively. Univariate analysis revealed an association between the following characteristics and short-term problems after NSM combined with breast reconstruction: axillary lymph node dissection, age >42 years, BMI >24 kg/m2, type of surgical incision, and type of breast reconstruction technique (Table 2). Significant variables found in the univariate study were incorporated into a logistic regression model through multivariate analysis (Table 3). The findings revealed that an increased risk of short-term problems was linked to age >42 years, BMI >24 kg/m2, periareolar and tumor surface incisions, and implant + ADM ± serratus anterior breast reconstruction. Compared with individuals under 42 years of age, individuals over 42 years of age presented a 2.476-fold increased risk of short-term problems (p <0.005). Patients had a 1.835-fold increased risk if their BMI was greater than 24 kg/m2. Patients who underwent breast reconstruction with implants + latissimus dorsi had a 0.311 lower risk of short-term problems (p=0.001) than those who underwent reconstruction with implants + mesh ± serratus anterior. Table 2. Results of single-factor analysis for factors impacting short-term breast complications following NSM combined with immediate breast reconstruction Clinical features Yes No χ² p Age (n=624) 21.678 0.000 ≤42 years old 45 300 ＞42 years old 78 201 BMI (n=624) 15.311 0.000 ≤24 kg/m 2 69 371 ＞24 kg/m 2 54 130 Smoking (n=624) 0.001 0.982 yes 2 8 no 121 493 History of breast surgery (n=624) 0.512 0.474 yes 12 39 no 111 462 Axillary node dissection (n=624) 1.146 0.284 yes 68 250 no 55 251 Neoadjuvant Chemotherapy(n=624) 0.336 0.56 yes 21 75 no 102 426 Chemotherapy（n=624） 0.037 0.847 yes 95 391 no 28 110 Radiation therapy（n=624） 3.305 0.069 yes 39 119 no 84 382 Endocrine therapy（n=624） 0.570 0.450 yes 89 345 no 34 156 Targeted therapy（n=624） 3.848 0.050 yes 32 91 no 91 410 Reconstruction styles (n=624) 11.662 0.009 Prosthesis + patch ± serratus anterior 52 188 Autologous flap (TRAM/DIEP/LD) 43 125 Prosthesis ± serratus anterior 14 70 Prosthesis + LD 14 118 Prosthesis volume (n=436) 3.568 0.059 ≤312 mL 31 182 >312 mL 48 175 Incision types (n=624) 14.360 0.002 Inframammary fold incision 10 94 Tumor surface incision 82 315 Areola incision 26 66 Others (axilla/other nonbreast surface incisions) 5 26 The ROC curve was used to obtain age, BMI, and prosthesis volume classification boundary values. Table 3. Multivariate analysis of factors influencing short-term breast complications following NSM combined with immediate breast reconstruction B SE Wald p OR 95% CI Age (>42 vs. ≦42) 0.907 0.218 17.281 0.000 2.476 1.615~3.796 BMI (>24 vs. ≦24) 0.607 0.225 7.290 0.007 1.835 1.181~2.852 Reconstruction styles (Prosthesis + patch ± serratus anterior) 12.020 0.007 Autologous flap (TRAM/DIEP/LD) -0.279 0.267 1.086 0.297 0.757 0.448~1.278 Prosthesis ± serratus anterior -0.548 0.357 2.362 0.124 0.578 0.287~1.163 Prosthesis + LD -1.168 0.345 11.439 0.001 0.311 0.158~0.612 Incision types (Inframammary fold incision) 15.886 0.001 Tumor surface incision 1.386 0.392 12.534 0.000 3.999 1.857~8.615 Areola incision 1.689 0.435 15.091 0.000 5.415 2.309~12.698 Others (axilla/other nonbreast surface incisions) 1.173 0.630 3.465 0.063 3.230 0.940~11.102 Age in years, BMI in kg/m 2 . B, unstandardized beta; SE, standard error for the unstandardized beta; OR, odds ratio; CI, confidence interval. We developed a column chart prediction model based on the multivariate logistic regression analysis results to predict the factors influencing short-term complications. This model was established on the basis of patient age, BMI, surgical incision type, and breast reconstruction method with R software (Figure 2). The C-index for this model was 0.715. In addition, we created a calibration curve for the column chart prediction model, which shows the actual likelihood of experiencing short-term difficulties on the Y-axis and the expected probability on the X-axis (Figure 3). The NAC necrosis rate was 11.38% (71/624) in our study. On the basis of a preliminary univariate analysis, a BMI greater than 24 kg/m2, the type of surgical incision, and the selected breast reconstruction technique were found to be associated with NAC necrosis (Table 4). With rates of 4.81% for IMF incisions, 11.59% for tumor surface incisions, 20.65% for periareolar incisions, and 3.23% for other incision types (such as axillary or other nonbreast surface incisions) (p=0.002), the likelihood of NAC necrosis varied depending on the type of surgical incision. Table 4. Results of univariate analysis for factors impacting nipple necrosis following NSM combined with immediate breast reconstruction Clinical features Yes No χ² p Age (n=624) 3.384 0.066 ≤42 years 32 313 ＞42 years 39 240 BMI (n=624) 11.125 0.001 ≤24 kg/m 2 38 402 ＞24 kg/m 2 33 151 Smoking (n=624) 0.019 0.682 yes 1 70 no 9 544 History of breast surgery (n=624) 1.022 0.312 yes 8 43 no 63 510 Axillary node dissection (n=624) 0.210 0.647 yes 38 280 no 33 273 Neoadjuvant Chemotherapy(n=624) 0.142 0.70 yes 12 84 no 59 469 Chemotherapy（n=624） 0.487 0.485 yes 53 433 no 18 120 Radiation therapy（n=624） 0.000 0.995 yes 18 140 no 53 413 Endocrine therapy（n=624） 0.029 0.865 yes 50 384 no 21 169 Targeted therapy（n=624） 0.907 0.341 yes 17 106 no 54 447 Reconstruction styles (n=624) 16.210 0.001 Prosthesis + patch ±serratus anterior 18 222 Autologous flap (TRAM/DIEP/LD) 33 135 Prosthesis ± serratus anterior 9 75 Prosthesis + LD 11 121 Prosthesis volume (n=436) 1.118 0.290 ≤312 mL 15 198 ＞312 mL 22 201 Incision types (n=624) 14.360 0.002 Inframammary fold incision 5 99 Tumor surface incision 46 351 Areola incision 19 73 Others (axilla/other nonbreast surface incisions) 1 30 The ROC curve obtained the thresholds of age, BMI, and prosthesis volume for categorization According to multivariate logistic regression analysis, BMI >24 kg/m2, periareolar incisions, and autologous breast reconstruction techniques (TRAM/DIEP/latissimus dorsi flap) were linked to an elevated incidence of NAC necrosis (Table 5). Patients with a BMI >24 kg/m2 had a 1.970-fold greater risk of NAC necrosis than did those with a BMI ≥24 kg/m2 (p=0.012). Patients with periareolar incisions had a 3.672-fold (p=0.021) increased incidence of IMF incisions and NAC necrosis. Patients opting for autologous breast reconstruction (TRAM/DIEP/latissimus dorsi flap) had a 2.241-fold greater risk of NAC necrosis (p=0.022) than those who underwent implant + ADM ± serratus anterior breast reconstruction. Table 5 Results of multivariate analysis identifying factors influencing nipple necrosis after immediate breast reconstruction following NSM B SE Wald p OR 95% CI BMI (>24 vs.≦24) 0.678 0.270 6.326 0.012 1.970 1.161~3.341 Reconstruction styles (Prosthesis + patch ± serratus anterior) 6.932 0.074 Autologous flap (TRAM/DIEP/LD) 0.807 0.352 5.269 0.022 2.241 1.125~4.463 Prosthesis ± serratus anterior 0.360 0.452 0.636 0.425 1.434 0.592~3.473 Prosthesis + LD 0.062 0.430 0.021 0.885 1.064 0.458~2.469 Incision types (Inframammary fold incision) 9.746 0.021 Tumor surface incision 0.578 0.538 1.154 0.283 1.782 0.621~5.116 Areola incision 1.301 0.565 5.293 0.021 3.672 1.212~11.121 Others (axilla/other nonbreast surface incisions) 0.714 1.148 0.387 0.534 0.490 0.052~4.648 BMI in kg/m 2 . B, unstandardized beta; SE, standard error for the unstandardized beta; OR, odds ratio; CI, confidence interval. Among the 71 patients with NAC necrosis, 3 underwent surgical excision; the remaining patients either had spontaneous detachment or improved with conservative treatment. As a result, 53 patients experienced nipple loss as a result of implant infection, ischemia necrosis, or recurrence, which led to an overall 91.50% (571/624) postoperative nipple preservation rate. 3. Oncological Safety of NSM Breast Reconstruction The OS of all patients was 98.7% (Figure 4). Thirteen patients experienced local recurrence (LR). We analyzed the effects of primary tumor stage, hormone receptor (HR) status, and human epidermal growth factor receptor 2 (HER-2) status on OS. The data revealed that these parameters had no significant effect on the overall survival of patients who received NSM combined with breast reconstruction (Figures 5, 6, and 7). We observed four cases of nipple-areolar complex recurrence (NCR) as the initial event. Two patients had received neoadjuvant therapy and did not consistently adhere to postoperative endocrine therapy medication. All patients who experienced NCR underwent local excision of the NAC, resulting in favorable postoperative recovery without compromising OS. The 10-year OS and DMFS rates for patients without NCR were 96.0% and 89.4%, respectively (p>0.05) (Figure 8a, 8b). In addition, 9 patients outside of the NCR group experienced local recurrence (LR). The 10-year OS and DMFS rates of the LR patients were 57.1% and 62.5%, respectively. The rates of LR-free individuals were 90.1% and 97.5%, respectively (p<0.0001) (Figure 9a, 9b). To determine potential indications of LR, age, axillary lymph node dissection, breast reconstruction method, pathological type, tumor stage, molecular subtype, and adjuvant therapy approach were examined. The results of the Cox proportional hazards regression model revealed that axillary lymph node metastasis was related to an increased probability of postoperative LR. Patients in the N3 stage had a 16.924-fold greater risk of LR than did those in the N0 stage after NSM combined with breast reconstruction (p=0.012) (Table 6). Table 6. Cox regression analysis results of factors influencing LR following NSM combined with immediate breast reconstruction B SE Wald p OR 95% CI Axillary nodes (N) 8.029 0.045 N1 -1.179 1.051 1.260 0.262 0.308 0.039~2.411 N2 0.284 1.054 0.073 0.788 1.328 0.168~10.490 N3 2.829 1.130 6.262 0.012 16.924 1.846~155.135 4. Evaluation of Breast Reconstruction Outcomes in patients who underwent NSM We employed the BREAST-Q to assess patient-reported outcomes. There were 574 individuals who underwent surgery after 2009. We collected responses to the BREAST-Q questionnaire (Tables 7.1 and 7.2) from 517 patients (90.07%, 517/574). The primary focus was to evaluate the nipple condition, including shape, position, color, convexity, symmetry, surgical scar positioning, and the transition between the NAC and the breast surface skin following NSM combined with breast reconstruction. Our study revealed that most patients were somewhat or very satisfied with the form, position, color, convexity, symmetry of the bilateral nipples, surgical scar location, and transition of the breast surface skin after NSM combined with breast reconstruction. Specifically, 41.0% of patients experienced sensations in their nipples, with 8.3% experiencing typical nipple sensitivity. Table 7.1 Results of the BREAST-Q score scale for breast reconstruction following NSM n=517 Very dissatisfied n (%) Dissatisfied n (%) Satisfied n (%) Very satisfied n (%) Q1 The shape of the nipple on the surgical side 3 (0.6) 29 (5.6) 253 (48.9) 232 (44.9) Q2 The position of the nipple on the surgical side 2 (0.6) 21 (4.1) 248 (48.0) 245 (47.4) Q3 The color of the nipple on the surgical side 3 (0.4) 15 (2.9) 225 (43.5) 275 (53.2) Q4 The convexity of the nipple on the surgical side 3 (0.6) 37 (7.2) 239 (46.2) 238 (46.0) Q5 Symmetry of bilateral nipples 3 (0.6) 63 (12.2) 258 (49.9) 193 (37.3) Q6 Location of surgical scars 3 (0.6) 62 (12.0) 195 (37.7) 257 (49.7) Q7 Breast surface-to-skin transition 0 (0.0) 67 (13.0) 197 (38.1) 253 (48.9) Table 7.2 Results of the BREAST-Q score scale for breast reconstruction following NSM n=517 No sensation n (%) Mild sensation n (%) Partial sensation n (%) Normal sensation n (%) Q1 Sensation of the nipple on the surgical side 213 (41.3) 92 (17.9) 169 (32.7) 43 (8.2) Q2 Sensation of the skin on the surgical side 90 (17.3) 109 (21.2) 248 (48.0) 70 (13.5) Discussion 1. Reduced incidence and controllable complications in NSM breast reconstruction NSM combined with breast reconstruction always has short-term complications, which include NAC necrosis, breast infections, breast flap necrosis, wound dehiscence or nonhealing, hemorrhage, fat necrosis, seroma, and hematoma. Our findings revealed that 19.7% of patients experienced short-term problems after surgery, with implant-based breast reconstruction accounting for 65.04% of this group. However, among individuals experiencing short-term problems, 25.20% required surgical intervention, but the majority improved with conservative care. On the basis of the findings of univariate and multivariate logistic regression studies, we created a nomogram prediction model to identify factors contributing to short-term complications after NSM combined with breast reconstruction. The model exhibited a C-index of 0.715 and underwent internal validation through a calibration curve, indicating its potential reference value. NAC necrosis can impact postoperative aesthetics. This model could be used by surgeons to help guide clinical decision-making by facilitating the prediction of short-term complications. However, larger sample sizes and additional external validation are still needed for the model. NAC necrosis may affect appearance after surgery. The incidence rates of NAC necrosis after NSM combined with breast reconstruction have been reported in previous research to range from 0–48%, with most studies reporting rates ranging from 10–15% [ 4 ]. Our results revealed an incidence rate of 11.38%, which is in line with the findings of previous studies. The majority of our cases' issues can be fixed with conservative care. A number of risk factors for NAC necrosis have been identified in prior studies, including diabetes, periareolar incisions, the type of breast reconstruction method selected, the thickness of the retained skin flap, preoperative radiation, and smoking [ 4 , 5 ]. Following NSM, the superficial capillary network of the nipple-areola dermis serves as the main source of blood supply for the NAC. The incision type is the main factor influencing NAC necrosis. The IMF incision could lower the overall complication rate after NSM in conjunction with breast reconstruction, as shown by Frey et al. [ 6 ]. Additionally, even though it provides a visual representation of the NAC and ducts, the periareolar incision increases the risk of necrosis and hinders blood circulation to the NAC [ 6 , 7 ]. The NAC necrosis rates were 4.81% for incisions made via the IMF, 11.59% for incisions made on the tumor surface, 20.65% for incisions made through the periareolar region, and 3.23% for incisions made through other nonbreast surface areas (p < 0.002). To minimize postoperative complications, we recommend giving priority to the IMF or nonbreast surface incisions wherever feasible. Our department has restricted the use of periareolar incisions since 2019. According to our research, individuals had a greater risk of developing NAC necrosis (p = 0.012) if their BMI was greater than 24 kg/m2. This result is in line with previous research findings [ 8 , 9 ]. Compared with implant-based procedures, autologous reconstruction increased the incidence of NAC necrosis by 2.241 times. A larger initial implant volume independently predicts complications in immediate breast reconstruction [ 10 , 11 ] because the autologous tissue flap volume increases postoperative tension on the breast skin, increasing the risk of NAC ischemic necrosis, and the principle applies to autologous breast reconstruction as well. Smoking is an additional risk factor for NAC necrosis, which also increases the likelihood of postoperative infections [ 12 , 13 ]. However, our investigation failed to yield conclusive findings in this regard, possibly due to the small number of smokers in the patient population. 2. Oncological safety of NSM combined with breast reconstruction The range of indications for nonsurgical breast remodeling (NSM) has increased in recent years, leading to an annual rise in the number of breast reconstructions following NSM [ 14 ]. Research has shown that its oncological safety is comparable to that of conventional breast surgeries [ 5 , 11 ]. There were no discernible differences in the LR or OS between the skin-sparing mastectomy and NSM groups, according to a retrospective review of 14 trials [ 15 ]. To maintain oncological safety, we only use thin skin flaps with a dermal subcapillary network and a subcutaneous fat thickness of less than 5 mm for NSM of malignant breast tumors. In long-term follow-up, LR after NSM has been reported to occur between 0% and 8.5% of the time; our study reported an LR rate of 2.13%, which is in line with other studies. Patients with LR have different prognoses depending on the region [ 16 , 17 ]. The NCR does not lead to a poor prognosis when patients are treated properly [ 18 , 19 ]. Four cases of NCR were included in our investigation, and the results revealed no discernible impact on the OS or DMFS of the patients (p > 0.05). On the other hand, LR types other than NCR significantly affected patients' OS and DMFS (p < 0.0001). Our findings suggest that individuals with NCRs and those with LRs in various regions have different disease development patterns. 3. Patients who underwent NSM breast reconstruction reported high satisfaction rates Compared with alternative breast cancer surgical techniques, nonspinal closure (NSM) optimizes the physical integrity preserved in patients and helps them restore confidence. The majority of participants in our study indicated satisfaction with the appearance of their nipples after the operation. Studies have shown that patients who undergo NSM combined with immediate breast reconstruction prefer to score higher on psychological, social, and sexual health assessments than those who undergo other surgeries, such as nipple reconstruction [ 20 , 21 ]. The potential decrease or loss of nipple sensation or pigment is a significant complication of NSM breast reconstruction. Our BREAST-Q includes only nipple assessments; it ignores evaluations of breast shape, psychological and sexual pleasure, and other variables that need to be further refined. A total of 8.3% of patients in our study reported having normal nipple sensation, whereas 41.0% had some nipple sensitivity. According to Sisco and Yao, there are differences in the sensory outcomes that follow NSM; the probability of self-reported normal sensation varies from 10–43% [ 22 ]. Conclusions Compared with other breast cancer operations, NSM requires that breast surgeons have a longer learning curve and require even greater proficiency [ 23 ]. The use of acellular dermal matrix in implant-based breast reconstruction has increased recently. For experienced surgical teams, NSM can be safely performed after an extensive evaluation of the link between the tumor and the NAC to ensure that pathological evaluations of tissue from the nipple base margin produce negative results. For all of our patients, we performed sharp dissection to reduce any further harm and prevent excessive traction during exposure. Typically, gauze is wrapped around the NAC following surgery to ensure adequate blood supply and prevent compression. The majority of patients with NAC necrosis in our study achieved favorable outcomes with conservative measures. NAC necrosis following NSM combined with breast reconstruction is relatively rare and can be prevented and controlled effectively. This study, which included 610 patients and 624 reconstructed breasts, is the first and largest comprehensive study on the effect of NSM on breast reconstruction in China. The results of this cohort highlight the excellent success rate of NSM in conjunction with prompt breast reconstruction and the low frequency of complications requiring surgical intervention. Reconstruction with implants and acellular dermal matrix (ADM) with or without serratus anterior, age > 42 years, BMI > 24 kg/m2, and periareolar incisions are independent risk factors for short-term complications following NSM. Furthermore, a BMI > 24 kg/m², periareolar incisions, and autologous breast reconstruction increase the chance of NAC ischemic necrosis after surgery. NCR events were infrequent and had no significant impact on OS in our study. After NSM combined with breast reconstruction, the majority of patients reported "satisfaction" or "high satisfaction" with the shape, position, color, convexity, bilateral symmetry, scar location, and skin transition of the nipple. Additionally, nearly half of these patients reported nipple sensation. In summary, NSM combined with breast reconstruction results in positive aesthetic outcomes, high patient satisfaction, and reliable oncological safety. Declarations Funding: The study was supported by the Special Foundation for Project and Team Development Grant (XB202008). The categories of this manuscript are as follows : Original article Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. This paper is based on a previous communication on the 2023 CCHIO Data availability statement : The data involved in this paper will be available from the corresponding author on reasonable request. And should be permitted from the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital. Ethics statement: All the clinical data related in this study were approved by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (EK20240412). This study was performed in accordance with the principles of the Declaration of Helsinki. The patients/participants provided written informed consent to participate in this study. References WU Z Y et al. Locoregional recurrence following nipple-sparing mastectomy with immediate breast reconstruction: Patterns and prognostic significance[J]. Eur. J. Surg. Oncol. 47 (6), 1309–1315 (2021). WU Z Y, KIM H J, L. E. E. J. W. et al. Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer[J]. JAMA Surg. 154 (11), 1030–1037 (2019). WEBER W P, HAUG, M. et al. KURZEDER C,. Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy[J]. Breast Cancer Res Treat, 172(3): 523 – 37. (2018). FREEMAN B S. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement[J]. Plast. Reconstr. Surg. Transpl. Bull. 30 , 676–682 (1962). AHN S J et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy[J]. Eur. J. Surg. Oncol. 44 (8), 1170–1176 (2018). VAN DEVENTER P V. The blood supply to the nipple-areola complex of the human mammary gland[J]. Aesthetic Plast. Surg. 28 (6), 393–398 (2004). FREY, J. D. et al. Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm[J]. Plast. Reconstr. Surg. 142 (6), 826e–35e (2018). GALIMBERTI, V. & MORIGI, C. Oncological Outcomes of Nipple-Sparing Mastectomy: A Single-Center Experience of 1989 Patients[J]. Ann. Surg. Oncol. 25 (13), 3849–3857 (2018). DAAR D A, ABDOU S A, ROSARIO, L. et al. Is There a Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis[J]. Plast. Reconstr. Surg. 143 (5), 906e–19e (2019). COLWELL, A. S. et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends[J]. Plast. Reconstr. Surg. 133 (3), 496–506 (2014). CHOI, M. et al. Breast in a Day: Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy[J]. Plast. Reconstr. Surg. 138 (2), 184e–91e (2016). FREY, J. D. et al. Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies[J]. Plast. Reconstr. Surg. 139 (6), 1300–1310 (2017). MARGENTHALER, J. A. et al. Oncologic Safety and Outcomes in Patients Undergoing Nipple-Sparing Mastectomy[J]. J. Am. Coll. Surg. 230 (4), 535–541 (2020). GARWOOD E R, MOORE, D. et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients[J]. Ann. Surg. 249 (1), 26–32 (2009). LOTFI, P. et al. Hyperbaric Oxygen Therapy and Mastectomy Flap Ischemia following Nipple-Sparing Mastectomy and Immediate Breast Reconstruction[J]. Plast. Reconstr. Surg. 145 (6), 1114e–5e (2020). AGHA R A, AL OMRAN Y, WELLSTEAD, G. et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy[J]. BJS Open. 3 (2), 135–145 (2019). GARSTKA, M. et al. How Protective are Nipple-Sparing Prophylactic Mastectomies in BRCA1 and BRCA2 Mutation Carriers?[J]. Ann. Surg. Oncol. 28 (10), 5657–5662 (2021). STANEK, K. et al. Bilateral Prophylactic Nipple-Sparing Mastectomy: Analysis of the Risk-Reducing Effect in BRCA1/2 Mutation Carriers[J]. Aesthetic Plast. Surg. 46 (2), 706–711 (2022). CHAMBERLAIN, M. U. R. T. H. Y. V. Nipple-sparing mastectomy in modern breast practice[J]. Clin. Anat. 26 (1), 56–65 (2013). LANGSTEIN H N et al. Breast cancer recurrence after immediate reconstruction: patterns and significance[J]. Plast. Reconstr. Surg. , 111 (2): (2003). 712 – 20; discussion 21 – 2. SAKURAI, T. et al. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution[J]. Med. Oncol. 30 (1), 481 (2013). WEI C H et al. Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction[J]. Breast J. 22 (1), 10–17 (2016). HALLBECK, M. S. et al. Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM[J]. Ann. Surg. Oncol. 27 (5), 1318–1326 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Jan, 2025 Reviews received at journal 13 Jan, 2025 Reviews received at journal 09 Jan, 2025 Reviewers agreed at journal 18 Dec, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers invited by journal 14 Nov, 2024 Editor assigned by journal 09 Nov, 2024 Editor invited by journal 07 Nov, 2024 Submission checks completed at journal 04 Nov, 2024 First submitted to journal 16 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5276211","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":378099711,"identity":"1510d934-65e9-4a4b-bef8-3bc651917892","order_by":0,"name":"Bowen Ding","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bowen","middleName":"","lastName":"Ding","suffix":""},{"id":378099712,"identity":"11f50a10-cd83-4cca-8a9c-694d82f994ad","order_by":1,"name":"Jie Wang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Wang","suffix":""},{"id":378099713,"identity":"f6450306-574a-4015-9019-a4c4c5e102cf","order_by":2,"name":"Shanshan He","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"He","suffix":""},{"id":378099714,"identity":"5586612e-1db2-49de-b814-a4d5640d7804","order_by":3,"name":"Qingfeng Huang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qingfeng","middleName":"","lastName":"Huang","suffix":""},{"id":378099715,"identity":"c26c2bcd-934e-4e3c-946d-aa1b1f4fbe57","order_by":4,"name":"Jian 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17:07:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70647,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of study population inclusion\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/77ac06de3f359dc684731976.png"},{"id":70385359,"identity":"4f333a6a-8cb7-4931-9f31-0bf6d5f92c12","added_by":"auto","created_at":"2024-12-02 17:07:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":140623,"visible":true,"origin":"","legend":"\u003cp\u003eNomogram illustrating the factors affecting short-term breast complications following NSM combined with breast reconstruction\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/01230bb2bed5bf7e73ff1ce0.png"},{"id":70385323,"identity":"44868625-ae34-4469-9d42-78f328a52494","added_by":"auto","created_at":"2024-12-02 17:06:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":68680,"visible":true,"origin":"","legend":"\u003cp\u003eCalibration curve for the nomogram predicting factors affecting the short-term breast complications following NSM combined with breast reconstruction\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/e4d7c4219b606d31fea24dc0.png"},{"id":70385330,"identity":"1aae249a-7313-48d5-ae63-2dab98cb033e","added_by":"auto","created_at":"2024-12-02 17:07:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":52857,"visible":true,"origin":"","legend":"\u003cp\u003eOS curves of all patients\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/69073d59eb10f58ef6cd2ab2.png"},{"id":70385317,"identity":"299bea1c-1579-459f-abf5-9e46d8fd525c","added_by":"auto","created_at":"2024-12-02 17:06:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":60479,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of OS in patients with different tumor staging\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/58e3a8425a9f3b3a05e817f9.png"},{"id":70385387,"identity":"b49cd3a7-2db9-475c-9adc-ed3e6a27b37a","added_by":"auto","created_at":"2024-12-02 17:08:45","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":60884,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of OS in patients with different HR status\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/b9dd167c7e23ac31141c1669.png"},{"id":70385377,"identity":"651873f3-4bc3-4d9b-ad3f-f581309d4044","added_by":"auto","created_at":"2024-12-02 17:08:18","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":65846,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of OS in patients with varied HER-2 status\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/e9c64694a7c99966407600d0.png"},{"id":70385315,"identity":"80b9d4bb-f5cf-4a3e-9886-bd3ffef14a4c","added_by":"auto","created_at":"2024-12-02 17:06:40","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":113911,"visible":true,"origin":"","legend":"\u003cp\u003ea Comparison of DMFS between patients with and without NCR\u003c/p\u003e\n\u003cp\u003eb Comparison of OS between patients with and without NCR\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/94902d3f5b6ce43c9448366c.png"},{"id":70385350,"identity":"39a688e6-f75d-4abd-a210-80c2dfaf6590","added_by":"auto","created_at":"2024-12-02 17:07:35","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":118324,"visible":true,"origin":"","legend":"\u003cp\u003ea Comparison of DMFS among patients without NCR who experienced LR and those who remained LR-free\u003c/p\u003e\n\u003cp\u003eb Comparison of OS among patients without NCR who experienced LR and those who remained LR-free\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/56628e6f65915e2557bd9986.png"},{"id":70387500,"identity":"4cfa4c6e-ab1c-4b20-a7b5-7b2f1105bf6d","added_by":"auto","created_at":"2024-12-02 17:24:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1439835,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5276211/v1/177bde87-ba14-4d4b-bc32-d9135f7b62dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical feature and patient-report outcome of nipple-sparing mastectomy with immediate breast reconstruction: a eighteen-year cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe evolution of breast surgery, from radical mastectomy and skin-sparing mastectomy to nipple-sparing mastectomy (NSM), has improved postoperative aesthetic outcomes and patient satisfaction substantially; moreover, all of these methods maintain oncological safety [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite the increasing risk of local recurrence, preserving the nipple‒areola complex (NAC) still has the same oncological safety as other breast surgeries do [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The treatment objective for breast cancer has shifted from simply improving patient survival to emphasizing postoperative quality of life and aesthetic outcomes. Clinicians are concerned about minimizing surgical complications, and there is a need to evaluate patient satisfaction after NSM combined with breast reconstruction in China.\u003c/p\u003e \u003cp\u003eWe conducted a comprehensive analysis of patient demographics, tumor characteristics, and surgical factors to identify the key contributors to short-term complications. Additionally, we developed and validated a predictive model utilizing a line chart to assess the risk of short-term postoperative complications. Furthermore, we examined the risk factors associated with NAC necrosis in patients who underwent NSM in conjunction with breast reconstruction. We also assessed patient-reported outcomes and ensured the oncological safety of this surgical approach. The subsequent sections detail our findings.\u003c/p\u003e"},{"header":"Methods","content":" \u003cp\u003e1. Patient characteristics\u003c/p\u003e \u003cp\u003eWe conducted a retrospective analysis of clinical data from 635 female patients who underwent nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction at our department between June 2005 and August 2022. Eighteen patients were excluded because they underwent NSM for non-breast malignancies, and 7 patients who underwent subcutaneous glandular tissue preservation surgery for ductal carcinoma in situ of the breast were also excluded. The final study cohort consisted of 610 patients, including 14 who underwent bilateral NSM (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The patients ranged in age from 21\u0026ndash;70 years, with a mean age of 41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 years. Their body mass index (BMI) ranged from 16.02 to 34.17 kg/m2, with a mean BMI of 22.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78 kg/m2. All patients provided signed informed consent forms prior to surgery. All the clinical data related in this study were approved by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (EK20240412). This study was performed in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003e2. Research methods\u003c/p\u003e \u003cp\u003eThe study's inclusion criteria were as follows: (1) NSM followed by immediate breast reconstruction conducted within the breast reconstruction department; (2) confirmed breast malignancy through preoperative biopsy; and (3) absence of NAC involvement in both clinical and imaging examinations, including ultrasound, mammography, and magnetic resonance imaging, with negative pathological results for the NAC base margins.\u003c/p\u003e \u003cp\u003eThe exclusion criteria included the following: (1) a negative pathological outcome in frozen sections of the NAC base margins, combined with the detection of residual cancer cells in paraffin-embedded sections; (2) surgical pathology confirmation of benign breast disease; (3) prophylactic mastectomy; (4) subcutaneous glandular tissue resection surgery for various reasons; and (5) significant and irreversible loss of clinical data.\u003c/p\u003e \u003cp\u003eAll patients underwent pathological examination of the nipple‒areola complex in conjunction with intraoperative frozen pathological assessment. In cases where residual cancer tissue was identified in the nipple base tissue, a subsequent surgical intervention was undertaken to excise the nipple or NAC.\u003c/p\u003e \u003cp\u003eWe conducted a comprehensive follow-up study by thoroughly examining patient medical records, outpatient visits, and telephone communications. The follow-up period lasted until November 2022, with an average duration of 50.56\u0026thinsp;\u0026plusmn;\u0026thinsp;40.28 months (ranging from 12 to 204 months). The clinical information gathered from patients included various aspects, such as age at diagnosis, BMI, smoking history, prior history of breast surgery, surgical duration, surgical side, incision type, axillary lymph node dissection, type of breast reconstruction, postoperative adjuvant treatment, and postoperative complications. Short-term breast complications were defined as those that occurred within three months of the initial surgery.\u003c/p\u003e \u003cp\u003eNAC ischemic necrosis specifically refers to any ischemic condition affecting the nipple‒areola complex that requires local wound care. Patient satisfaction was assessed via the BREAST-Q questionnaire. Additionally, patients were rigorously monitored for any sign of recurrence, metastasis, or survival. The time interval of recurrence or metastasis was determined from the surgery date to the occurrence of the respective event.\u003c/p\u003e \u003cp\u003eOur primary endpoints of interest include total complications, nipple-areolar necrosis, nipple-areola complex (NCR) recurrence, local recurrence (LR), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Our secondary endpoint was patient-reported outcomes. DMFS was defined as the time interval from the surgical procedure to the initial occurrence of distant metastasis. OS was defined as the period from surgery to the date of death. The LR, which does not include the NCR, encompasses cancer metastasis to the ipsilateral skin, chest wall, axilla, and supraclavicular lymph nodes.\u003c/p\u003e \u003cp\u003eNipple satisfaction was categorized into 4 levels: 1\u0026thinsp;=\u0026thinsp;very dissatisfied, 2\u0026thinsp;=\u0026thinsp;somewhat dissatisfied, 3\u0026thinsp;=\u0026thinsp;somewhat satisfied, and 4\u0026thinsp;=\u0026thinsp;very satisfied. Similarly, nipple or breast skin sensation was classified into 4 levels: 1\u0026thinsp;=\u0026thinsp;no sensation, 2\u0026thinsp;=\u0026thinsp;slight sensation, 3\u0026thinsp;=\u0026thinsp;partial sensation, and 4\u0026thinsp;=\u0026thinsp;normal sensation.\u003c/p\u003e \u003cp\u003eStatistical analyses were performed via SPSS 24.0 and R software (version 4.2.2). Chi-square tests, analysis of variance (ANOVA), and Fisher's exact probability tests were employed to compare clinical characteristics. The classification threshold for continuous variables was determined via the receiver operating characteristic (ROC) curve. Univariate analysis was utilized to identify potential risk factors associated with short-term complications following breast surgery. Variables found to be significant in the univariate analysis were subsequently included in a multivariate logistic regression analysis. A predictive model was developed for short-term postbreast surgery complications through regression analysis via R software. The model's predictive accuracy was assessed via the concordance index (C-index) and calibration curve, with the line chart model created via the \"rms\" and \"rmda\" packages. Furthermore, both univariate and multivariate logistic regression models were utilized to examine potential risk factors for nipple‒areola complex (NAC) necrosis following nipple‒sparing mastectomy (NSM) in conjunction with breast reconstruction. We used multivariate ordinal logistic regression analysis to determine the factors impacting patient satisfaction. The Kaplan\u0026ndash;Meier method was used to analyze survival, and the log-rank test was used to statistically evaluate differences in survival. A two-tailed p value threshold of 0.05 was used to assess statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Surgical outcomes\u003c/p\u003e\n\u003cp\u003eIn this study, NSM incisions comprised inframammary fold (IMF) incisions in 16.7% (104/624) of\u0026nbsp;the\u0026nbsp;cases;\u0026nbsp;tumor surface incisions (including radial, arc-shaped, spindle-shaped, or circular incisions on the tumor surface) in 63.6% (397/624) of\u0026nbsp;the\u0026nbsp;patients;\u0026nbsp;periareolar incisions in 14.7% (92/624) (including periareolar \u0026plusmn; extended lateral or medial incisions and omega incisions);\u0026nbsp;and\u0026nbsp;other incisions\u0026nbsp;(including axillary or other\u0026nbsp;nonbreast\u0026nbsp;surface incisions) in 5.0% (31/624). Breast reconstruction methods included implant + ADM \u0026plusmn; serratus anterior in 38.5% (240/624) of patients, implant \u0026plusmn; serratus anterior in 13.3% (83/624), implant + latissimus dorsi in 21.2% (132/624),\u0026nbsp;autologous reconstruction in 27.1% (169/624) (encompassing transverse rectus abdominis musculocutaneous flap (TRAM), deep inferior epigastric perforator flap (DIEP), and latissimus dorsi ([LD] flap), implant \u0026plusmn; serratus anterior in 13.3% (83/624), and implant + latissimus dorsi in 21.2% (132/624). Both one-stage and two-stage breast reconstructions using breast\u0026nbsp;prostheses\u0026nbsp;were categorized as implant-based reconstructions in this study (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. Clinicopathological features of patients\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"76%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eClinicopathological features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge (n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026le;42 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e341 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;42 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e269 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI (n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026le;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e434 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e176 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSides\u0026nbsp;(n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLeft side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e273 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRight side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e323 (53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStage\u0026nbsp;(n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0-I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e257(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eII-III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e353(57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHER-2 Status\u0026nbsp;(n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHER-2(-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e466(76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHER-2(+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e144(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHR Status(n=610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHR\u0026lt;1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e137(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHR\u0026ge;1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e473(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBreast reconstruction techniques\u0026nbsp;(n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProsthesis + patch \u0026plusmn; serratus anterior muscle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e240 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAutologous flap (TRAM/DIEP/latissimus dorsi)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e169 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProsthesis \u0026plusmn; serratus anterior muscle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProsthesis + LD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e132 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIncision types (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInframammary fold incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTumor surface incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e397 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAreola incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOthers (axilla/other nonbreast surface incisions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Complications and Factors\u0026nbsp;Affecting\u0026nbsp;Breast Reconstruction following NSM\u003c/p\u003e\n\u003cp\u003eThe short-term complication rate following NSM combined with breast reconstruction was 19.7% (123/624). The complications included\u0026nbsp;nipple‒areolar\u0026nbsp;complex (NAC) necrosis, breast infection, breast flap necrosis, incision\u0026nbsp;nonhealing\u0026nbsp;or dehiscence, hemorrhage, fat necrosis, seroma, and hematoma. Among patients who\u0026nbsp;experienced\u0026nbsp;short-term problems, 25.20% (31/123) underwent surgery, while the others were treated conservatively.\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed an association\u0026nbsp;between the following characteristics\u0026nbsp;and\u0026nbsp;short-term problems after NSM combined with breast reconstruction: axillary lymph node dissection, age \u0026gt;42\u0026nbsp;years, BMI \u0026gt;24 kg/m2, type of surgical incision, and\u0026nbsp;type of\u0026nbsp;breast reconstruction technique (Table 2). Significant variables found in the univariate study were incorporated into a logistic regression model through multivariate analysis (Table 3). The findings\u0026nbsp;revealed\u0026nbsp;that an increased risk of short-term problems was linked to age \u0026gt;42 years, BMI \u0026gt;24 kg/m2, periareolar and tumor surface incisions, and implant + ADM \u0026plusmn; serratus anterior breast reconstruction.\u0026nbsp;Compared with individuals under 42 years of age, individuals\u0026nbsp;over 42 years\u0026nbsp;of age presented\u0026nbsp;a 2.476-fold increased risk of short-term problems (p \u0026lt;0.005). Patients had a 1.835-fold increased risk if their BMI was greater than 24 kg/m2.\u0026nbsp;Patients who underwent breast reconstruction with\u0026nbsp;implants\u0026nbsp;+ latissimus dorsi had a 0.311\u0026nbsp;lower\u0026nbsp;risk of short-term problems (p=0.001)\u0026nbsp;than\u0026nbsp;those who underwent reconstruction with\u0026nbsp;implants\u0026nbsp;+ mesh \u0026plusmn; serratus anterior.\u003c/p\u003e\n\u003cp\u003eTable 2. Results of\u0026nbsp;single-factor analysis for factors impacting short-term breast complications following NSM combined with immediate breast\u0026nbsp;reconstruction\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 265px;\"\u003e\n \u003cp\u003eClinical features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eAge\u0026nbsp;(n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e21.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026le;42 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;＞42 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eBMI (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e15.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026le;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e＞24\u0026nbsp;kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eSmoking (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eHistory of breast surgery (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eAxillary node dissection (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e1.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eNeoadjuvant Chemotherapy(n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eChemotherapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eRadiation therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e3.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eEndocrine therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eTargeted therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e3.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eReconstruction styles\u0026nbsp;(n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e11.662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eProsthesis + patch \u0026plusmn; serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eAutologous flap (TRAM/DIEP/LD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eProsthesis \u0026plusmn; serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eProsthesis + LD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eProsthesis volume\u0026nbsp;(n=436)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e3.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e\u0026le;312 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003e\u0026gt;312 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eIncision types (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e14.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eInframammary fold incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eTumor surface incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eAreola incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.5763%;\"\u003e\n \u003cp\u003eOthers (axilla/other nonbreast surface incisions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8492%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.2352%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2855%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe ROC curve was used to obtain age, BMI, and prosthesis volume classification boundary values.\u003c/p\u003e\n\u003cp\u003eTable 3. Multivariate analysis of factors influencing short-term breast complications following NSM combined with immediate breast reconstruction\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eAge (\u0026gt;42 vs. ≦42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e17.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e2.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e1.615~3.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eBMI (\u0026gt;24 vs. ≦24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e7.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e1.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e1.181~2.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eReconstruction styles (Prosthesis + patch \u0026plusmn; serratus anterior)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e12.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eAutologous flap (TRAM/DIEP/LD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e-0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e0.448~1.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eProsthesis \u0026plusmn; serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e-0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e2.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e0.287~1.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eProsthesis + LD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e-1.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e11.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e0.158~0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eIncision types (Inframammary fold incision)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e15.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eTumor surface incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e1.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e12.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e3.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e1.857~8.615\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eAreola incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e1.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e15.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e5.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e2.309~12.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.8462%;\"\u003e\n \u003cp\u003eOthers (axilla/other nonbreast surface incisions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e1.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.57265%;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5983%;\"\u003e\n \u003cp\u003e3.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.88889%;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23077%;\"\u003e\n \u003cp\u003e3.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2906%;\"\u003e\n \u003cp\u003e0.940~11.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAge in years, BMI in\u0026nbsp;kg/m\u003csup\u003e2\u003c/sup\u003e. B, unstandardized beta; SE, standard error for the unstandardized beta; OR, odds ratio; CI, confidence interval.\u003c/p\u003e\n\u003cp\u003eWe developed a column chart prediction model based on the multivariate logistic regression analysis results to predict the factors influencing short-term complications. This model was established on the basis of patient age, BMI, surgical incision type, and breast reconstruction method with R software (Figure 2). The C-index for this model was 0.715. In addition, we created a calibration curve for the column chart prediction model, which shows the actual likelihood of experiencing short-term difficulties on the Y-axis and the expected probability on the X-axis (Figure 3).\u003c/p\u003e\n\u003cp\u003eThe NAC necrosis rate was 11.38% (71/624) in our study.\u0026nbsp;On the basis of\u0026nbsp;a preliminary univariate analysis,\u0026nbsp;a\u0026nbsp;BMI greater than 24 kg/m2, the\u0026nbsp;type\u0026nbsp;of surgical incision, and the selected breast reconstruction technique were found to be\u0026nbsp;associated\u0026nbsp;with NAC necrosis (Table 4). With rates of 4.81% for IMF incisions, 11.59% for tumor surface incisions, 20.65% for periareolar incisions, and 3.23% for other incision types (such as axillary or other\u0026nbsp;nonbreast\u0026nbsp;surface incisions) (p=0.002), the likelihood of NAC necrosis varied depending on the\u0026nbsp;type\u0026nbsp;of surgical incision.\u003c/p\u003e\n\u003cp\u003eTable 4. Results of univariate analysis for factors impacting nipple necrosis following NSM combined with immediate breast reconstruction\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eClinical features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eAge (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e3.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;42 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;＞42 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eBMI (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e11.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e＞24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eSmoking (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eHistory of breast surgery (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eAxillary node dissection (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 235px;\"\u003e\n \u003cp\u003eNeoadjuvant Chemotherapy(n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 235px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 235px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003e469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eChemotherapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eRadiation therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eEndocrine therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eTargeted therapy（n=624）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eReconstruction styles (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e16.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eProsthesis + patch\u0026nbsp;\u0026plusmn;serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eAutologous flap (TRAM/DIEP/LD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eProsthesis\u0026nbsp;\u0026plusmn;\u0026nbsp;serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eProsthesis + LD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eProsthesis volume (n=436)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e\u0026le;312 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e＞312 mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eIncision types (n=624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e14.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eInframammary fold incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eTumor surface incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eAreola incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eOthers (axilla/other nonbreast surface incisions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe ROC curve obtained the thresholds of age, BMI, and prosthesis volume for categorization\u003c/p\u003e\n\u003cp\u003eAccording to multivariate logistic regression analysis, BMI \u0026gt;24 kg/m2, periareolar incisions, and autologous breast reconstruction techniques (TRAM/DIEP/latissimus dorsi flap) were linked to an elevated incidence of NAC necrosis (Table 5). Patients with a BMI \u0026gt;24 kg/m2 had a 1.970-fold greater risk of NAC necrosis than did those with a BMI \u0026ge;24 kg/m2 (p=0.012). Patients with periareolar incisions had a 3.672-fold (p=0.021) increased incidence of IMF incisions and NAC necrosis. Patients opting for autologous breast reconstruction (TRAM/DIEP/latissimus dorsi flap) had a 2.241-fold greater risk of NAC necrosis (p=0.022) than those who underwent implant + ADM \u0026plusmn; serratus anterior breast reconstruction.\u003c/p\u003e\n\u003cp\u003eTable 5 Results of multivariate analysis identifying factors influencing nipple necrosis after immediate breast reconstruction following NSM\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"572\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eBMI (\u0026gt;24 vs.≦24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e6.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e1.161~3.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eReconstruction styles (Prosthesis + patch \u0026plusmn; serratus anterior)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e6.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eAutologous flap (TRAM/DIEP/LD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e5.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e2.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e1.125~4.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eProsthesis \u0026plusmn; serratus anterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e0.592~3.473\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eProsthesis + LD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e0.458~2.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eIncision types (Inframammary fold incision)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e9.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eTumor surface incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e0.621~5.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eAreola incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e1.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e5.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e3.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e1.212~11.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.0998%;\"\u003e\n \u003cp\u003eOthers (axilla/other nonbreast surface incisions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.80736%;\"\u003e\n \u003cp\u003e1.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.98249%;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.63222%;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2137%;\"\u003e\n \u003cp\u003e0.052~4.648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBMI in\u0026nbsp;kg/m\u003csup\u003e2\u003c/sup\u003e. B, unstandardized beta; SE, standard error for the unstandardized beta; OR, odds ratio;\u0026nbsp;CI, confidence interval.\u003c/p\u003e\n\u003cp\u003eAmong the 71 patients with NAC necrosis, 3 underwent surgical excision; the remaining patients either had spontaneous detachment or improved with conservative treatment. As a result, 53 patients experienced nipple loss as a result of implant infection, ischemia necrosis, or recurrence, which led to an overall 91.50% (571/624) postoperative nipple preservation rate.\u003c/p\u003e\n\u003cp\u003e3. Oncological Safety of NSM Breast Reconstruction\u003c/p\u003e\n\u003cp\u003eThe OS of all patients was 98.7% (Figure 4). Thirteen patients experienced local recurrence (LR). We analyzed the effects of primary tumor stage, hormone receptor (HR) status, and human epidermal growth factor receptor 2 (HER-2) status on OS. The data revealed that these parameters had no significant effect on the overall survival of patients who received NSM combined with breast reconstruction (Figures 5, 6, and 7).\u003c/p\u003e\n\u003cp\u003eWe observed four cases of nipple-areolar complex recurrence (NCR) as the initial event. Two patients had received neoadjuvant therapy and did not consistently adhere to postoperative endocrine therapy medication. All patients who experienced NCR underwent local excision of the NAC, resulting in favorable postoperative recovery without compromising OS. The 10-year OS and DMFS rates for patients without NCR were 96.0% and 89.4%, respectively (p\u0026gt;0.05) (Figure 8a, 8b).\u003c/p\u003e\n\u003cp\u003eIn addition, 9 patients outside of the NCR group experienced local recurrence (LR). The 10-year OS and DMFS rates of the LR patients were 57.1% and 62.5%, respectively. The rates of LR-free individuals were 90.1% and 97.5%, respectively (p\u0026lt;0.0001) (Figure 9a, 9b). To determine potential indications of LR, age, axillary lymph node dissection, breast reconstruction method, pathological type, tumor stage, molecular subtype, and adjuvant therapy approach were examined. The results of the Cox proportional hazards regression model revealed that axillary lymph node metastasis was related to an increased probability of postoperative LR. Patients in the N3 stage had a 16.924-fold greater risk of LR than did those in the N0 stage after NSM combined with breast reconstruction (p=0.012) (Table 6).\u003c/p\u003e\n\u003cp\u003eTable 6. Cox regression analysis results of factors influencing LR following NSM combined with immediate breast reconstruction\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3158%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6316%;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3158%;\"\u003e\n \u003cp\u003eAxillary nodes (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6316%;\"\u003e\n \u003cp\u003e8.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3158%;\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e-1.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e1.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6316%;\"\u003e\n \u003cp\u003e1.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e0.039~2.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3158%;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e1.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6316%;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e1.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e0.168~10.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3158%;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e2.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e1.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6316%;\"\u003e\n \u003cp\u003e6.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.47368%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.5263%;\"\u003e\n \u003cp\u003e16.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0526%;\"\u003e\n \u003cp\u003e1.846~155.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Evaluation of Breast Reconstruction Outcomes in patients who underwent NSM\u003c/p\u003e\n\u003cp\u003eWe employed\u0026nbsp;the\u0026nbsp;BREAST-Q to assess patient-reported\u0026nbsp;outcomes. There were 574 individuals who\u0026nbsp;underwent\u0026nbsp;surgery after 2009. We collected responses to the BREAST-Q questionnaire (Tables 7.1 and 7.2) from 517 patients (90.07%, 517/574). The primary focus was to evaluate the nipple condition, including shape, position, color, convexity, symmetry, surgical scar positioning, and the transition between the NAC and the breast surface skin following NSM combined with breast reconstruction.\u003c/p\u003e\n\u003cp\u003eOur study revealed that most patients were somewhat or very satisfied with the form, position, color, convexity, symmetry of the bilateral nipples, surgical scar location, and transition of the breast surface skin after NSM combined with breast reconstruction. Specifically, 41.0% of patients experienced sensations in their nipples, with 8.3% experiencing typical nipple sensitivity.\u003c/p\u003e\n\u003cp\u003eTable 7.1 Results of the BREAST-Q score scale for breast reconstruction following NSM\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003en=517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003eVery dissatisfied\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ1 The shape of the nipple on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e29 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e253 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e232 (44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ2 The position of the nipple on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e21 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e248 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e245 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ3 The color of the nipple on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e3 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e15 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e225 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e275 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ4 The convexity of the nipple on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e37 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e239 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e238 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ5 Symmetry of bilateral nipples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e63 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e258 (49.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e193 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ6 Location of surgical scars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e62 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e195 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e257 (49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.3462%;\"\u003e\n \u003cp\u003eQ7 Breast surface-to-skin transition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1538%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.4231%;\"\u003e\n \u003cp\u003e67 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6923%;\"\u003e\n \u003cp\u003e197 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3846%;\"\u003e\n \u003cp\u003e253 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 7.2 Results of the BREAST-Q score scale for breast reconstruction following NSM\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.1923%;\"\u003e\n \u003cp\u003en=517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.4615%;\"\u003e\n \u003cp\u003eNo sensation\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eMild sensation\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003ePartial sensation\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3462%;\"\u003e\n \u003cp\u003eNormal sensation\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.1923%;\"\u003e\n \u003cp\u003eQ1 Sensation of the nipple on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.4615%;\"\u003e\n \u003cp\u003e213 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e92 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e169 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e43 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.1923%;\"\u003e\n \u003cp\u003eQ2 Sensation of the skin on the surgical side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.4615%;\"\u003e\n \u003cp\u003e90 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e109 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e248 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.3462%;\"\u003e\n \u003cp\u003e70 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e1. Reduced incidence and controllable complications in NSM breast reconstruction\u003c/p\u003e\u003cp\u003eNSM combined with breast reconstruction always has short-term complications, which include NAC necrosis, breast infections, breast flap necrosis, wound dehiscence or nonhealing, hemorrhage, fat necrosis, seroma, and hematoma. Our findings revealed that 19.7% of patients experienced short-term problems after surgery, with implant-based breast reconstruction accounting for 65.04% of this group. However, among individuals experiencing short-term problems, 25.20% required surgical intervention, but the majority improved with conservative care.\u003c/p\u003e \u003cp\u003eOn the basis of the findings of univariate and multivariate logistic regression studies, we created a nomogram prediction model to identify factors contributing to short-term complications after NSM combined with breast reconstruction. The model exhibited a C-index of 0.715 and underwent internal validation through a calibration curve, indicating its potential reference value.\u003c/p\u003e \u003cp\u003eNAC necrosis can impact postoperative aesthetics. This model could be used by surgeons to help guide clinical decision-making by facilitating the prediction of short-term complications. However, larger sample sizes and additional external validation are still needed for the model. NAC necrosis may affect appearance after surgery. The incidence rates of NAC necrosis after NSM combined with breast reconstruction have been reported in previous research to range from 0\u0026ndash;48%, with most studies reporting rates ranging from 10\u0026ndash;15% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Our results revealed an incidence rate of 11.38%, which is in line with the findings of previous studies. The majority of our cases' issues can be fixed with conservative care. A number of risk factors for NAC necrosis have been identified in prior studies, including diabetes, periareolar incisions, the type of breast reconstruction method selected, the thickness of the retained skin flap, preoperative radiation, and smoking [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFollowing NSM, the superficial capillary network of the nipple-areola dermis serves as the main source of blood supply for the NAC. The incision type is the main factor influencing NAC necrosis. The IMF incision could lower the overall complication rate after NSM in conjunction with breast reconstruction, as shown by Frey et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, even though it provides a visual representation of the NAC and ducts, the periareolar incision increases the risk of necrosis and hinders blood circulation to the NAC [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe NAC necrosis rates were 4.81% for incisions made via the IMF, 11.59% for incisions made on the tumor surface, 20.65% for incisions made through the periareolar region, and 3.23% for incisions made through other nonbreast surface areas (p\u0026thinsp;\u0026lt;\u0026thinsp;0.002). To minimize postoperative complications, we recommend giving priority to the IMF or nonbreast surface incisions wherever feasible. Our department has restricted the use of periareolar incisions since 2019. According to our research, individuals had a greater risk of developing NAC necrosis (p\u0026thinsp;=\u0026thinsp;0.012) if their BMI was greater than 24 kg/m2. This result is in line with previous research findings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Compared with implant-based procedures, autologous reconstruction increased the incidence of NAC necrosis by 2.241 times. A larger initial implant volume independently predicts complications in immediate breast reconstruction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] because the autologous tissue flap volume increases postoperative tension on the breast skin, increasing the risk of NAC ischemic necrosis, and the principle applies to autologous breast reconstruction as well.\u003c/p\u003e \u003cp\u003eSmoking is an additional risk factor for NAC necrosis, which also increases the likelihood of postoperative infections [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, our investigation failed to yield conclusive findings in this regard, possibly due to the small number of smokers in the patient population.\u003c/p\u003e\u003cp\u003e2. Oncological safety of NSM combined with breast reconstruction\u003c/p\u003e\u003cp\u003eThe range of indications for nonsurgical breast remodeling (NSM) has increased in recent years, leading to an annual rise in the number of breast reconstructions following NSM [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research has shown that its oncological safety is comparable to that of conventional breast surgeries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. There were no discernible differences in the LR or OS between the skin-sparing mastectomy and NSM groups, according to a retrospective review of 14 trials [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To maintain oncological safety, we only use thin skin flaps with a dermal subcapillary network and a subcutaneous fat thickness of less than 5 mm for NSM of malignant breast tumors.\u003c/p\u003e \u003cp\u003eIn long-term follow-up, LR after NSM has been reported to occur between 0% and 8.5% of the time; our study reported an LR rate of 2.13%, which is in line with other studies. Patients with LR have different prognoses depending on the region [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The NCR does not lead to a poor prognosis when patients are treated properly [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Four cases of NCR were included in our investigation, and the results revealed no discernible impact on the OS or DMFS of the patients (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). On the other hand, LR types other than NCR significantly affected patients' OS and DMFS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Our findings suggest that individuals with NCRs and those with LRs in various regions have different disease development patterns.\u003c/p\u003e \u003cp\u003e3. Patients who underwent NSM breast reconstruction reported high satisfaction rates\u003c/p\u003e \u003cp\u003eCompared with alternative breast cancer surgical techniques, nonspinal closure (NSM) optimizes the physical integrity preserved in patients and helps them restore confidence. The majority of participants in our study indicated satisfaction with the appearance of their nipples after the operation. Studies have shown that patients who undergo NSM combined with immediate breast reconstruction prefer to score higher on psychological, social, and sexual health assessments than those who undergo other surgeries, such as nipple reconstruction [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe potential decrease or loss of nipple sensation or pigment is a significant complication of NSM breast reconstruction. Our BREAST-Q includes only nipple assessments; it ignores evaluations of breast shape, psychological and sexual pleasure, and other variables that need to be further refined. A total of 8.3% of patients in our study reported having normal nipple sensation, whereas 41.0% had some nipple sensitivity. According to Sisco and Yao, there are differences in the sensory outcomes that follow NSM; the probability of self-reported normal sensation varies from 10\u0026ndash;43% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eCompared with other breast cancer operations, NSM requires that breast surgeons have a longer learning curve and require even greater proficiency [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The use of acellular dermal matrix in implant-based breast reconstruction has increased recently. For experienced surgical teams, NSM can be safely performed after an extensive evaluation of the link between the tumor and the NAC to ensure that pathological evaluations of tissue from the nipple base margin produce negative results. For all of our patients, we performed sharp dissection to reduce any further harm and prevent excessive traction during exposure. Typically, gauze is wrapped around the NAC following surgery to ensure adequate blood supply and prevent compression. The majority of patients with NAC necrosis in our study achieved favorable outcomes with conservative measures. NAC necrosis following NSM combined with breast reconstruction is relatively rare and can be prevented and controlled effectively.\u003c/p\u003e \u003cp\u003eThis study, which included 610 patients and 624 reconstructed breasts, is the first and largest comprehensive study on the effect of NSM on breast reconstruction in China. The results of this cohort highlight the excellent success rate of NSM in conjunction with prompt breast reconstruction and the low frequency of complications requiring surgical intervention. Reconstruction with implants and acellular dermal matrix (ADM) with or without serratus anterior, age\u0026thinsp;\u0026gt;\u0026thinsp;42 years, BMI\u0026thinsp;\u0026gt;\u0026thinsp;24 kg/m2, and periareolar incisions are independent risk factors for short-term complications following NSM. Furthermore, a BMI\u0026thinsp;\u0026gt;\u0026thinsp;24 kg/m\u0026sup2;, periareolar incisions, and autologous breast reconstruction increase the chance of NAC ischemic necrosis after surgery. NCR events were infrequent and had no significant impact on OS in our study. After NSM combined with breast reconstruction, the majority of patients reported \"satisfaction\" or \"high satisfaction\" with the shape, position, color, convexity, bilateral symmetry, scar location, and skin transition of the nipple. Additionally, nearly half of these patients reported nipple sensation. In summary, NSM combined with breast reconstruction results in positive aesthetic outcomes, high patient satisfaction, and reliable oncological safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by the Special Foundation for Project and Team Development Grant (XB202008).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecategories\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of this manuscript\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;are as follows\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOriginal\u0026nbsp;article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential\u0026nbsp;conflicts\u0026nbsp;of interest.\u003c/p\u003e\n\u003cp\u003eThis paper is based on a previous communication on the 2023 CCHIO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eavailability statement\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \u0026nbsp;data involved in this paper will be \u0026nbsp;available from the corresponding author on reasonable request. And should be permitted from the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estatement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the clinical data related in this study were approved by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (EK20240412). This study was performed in accordance with the principles of the Declaration of Helsinki. The patients/participants provided written informed consent to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWU Z Y et al. Locoregional recurrence following nipple-sparing mastectomy with immediate breast reconstruction: Patterns and prognostic significance[J]. \u003cem\u003eEur. J. Surg. Oncol.\u003c/em\u003e \u003cb\u003e47\u003c/b\u003e (6), 1309\u0026ndash;1315 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWU Z Y, KIM H J, L. E. E. J. W. et al. Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer[J]. \u003cem\u003eJAMA Surg.\u003c/em\u003e \u003cb\u003e154\u003c/b\u003e (11), 1030\u0026ndash;1037 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWEBER W P, HAUG, M. et al. KURZEDER C,. Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy[J]. Breast Cancer Res Treat, 172(3): 523\u0026thinsp;\u0026ndash;\u0026thinsp;37. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFREEMAN B S. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement[J]. \u003cem\u003ePlast. Reconstr. Surg. Transpl. Bull.\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e, 676\u0026ndash;682 (1962).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAHN S J et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy[J]. \u003cem\u003eEur. J. Surg. Oncol.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e (8), 1170\u0026ndash;1176 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVAN DEVENTER P V. The blood supply to the nipple-areola complex of the human mammary gland[J]. \u003cem\u003eAesthetic Plast. Surg.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (6), 393\u0026ndash;398 (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFREY, J. D. et al. Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e142\u003c/b\u003e (6), 826e\u0026ndash;35e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGALIMBERTI, V. \u0026amp; MORIGI, C. Oncological Outcomes of Nipple-Sparing Mastectomy: A Single-Center Experience of 1989 Patients[J]. \u003cem\u003eAnn. Surg. Oncol.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e (13), 3849\u0026ndash;3857 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDAAR D A, ABDOU S A, ROSARIO, L. et al. Is There a Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e143\u003c/b\u003e (5), 906e\u0026ndash;19e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOLWELL, A. S. et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e133\u003c/b\u003e (3), 496\u0026ndash;506 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHOI, M. et al. Breast in a Day: Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e138\u003c/b\u003e (2), 184e\u0026ndash;91e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFREY, J. D. et al. Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e139\u003c/b\u003e (6), 1300\u0026ndash;1310 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMARGENTHALER, J. A. et al. Oncologic Safety and Outcomes in Patients Undergoing Nipple-Sparing Mastectomy[J]. \u003cem\u003eJ. Am. Coll. Surg.\u003c/em\u003e \u003cb\u003e230\u003c/b\u003e (4), 535\u0026ndash;541 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGARWOOD E R, MOORE, D. et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients[J]. \u003cem\u003eAnn. Surg.\u003c/em\u003e \u003cb\u003e249\u003c/b\u003e (1), 26\u0026ndash;32 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLOTFI, P. et al. Hyperbaric Oxygen Therapy and Mastectomy Flap Ischemia following Nipple-Sparing Mastectomy and Immediate Breast Reconstruction[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e \u003cb\u003e145\u003c/b\u003e (6), 1114e\u0026ndash;5e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAGHA R A, AL OMRAN Y, WELLSTEAD, G. et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy[J]. \u003cem\u003eBJS Open.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (2), 135\u0026ndash;145 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGARSTKA, M. et al. How Protective are Nipple-Sparing Prophylactic Mastectomies in BRCA1 and BRCA2 Mutation Carriers?[J]. \u003cem\u003eAnn. Surg. Oncol.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (10), 5657\u0026ndash;5662 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTANEK, K. et al. Bilateral Prophylactic Nipple-Sparing Mastectomy: Analysis of the Risk-Reducing Effect in BRCA1/2 Mutation Carriers[J]. \u003cem\u003eAesthetic Plast. Surg.\u003c/em\u003e \u003cb\u003e46\u003c/b\u003e (2), 706\u0026ndash;711 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHAMBERLAIN, M. U. R. T. H. Y. V. Nipple-sparing mastectomy in modern breast practice[J]. \u003cem\u003eClin. Anat.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e (1), 56\u0026ndash;65 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLANGSTEIN H N et al. Breast cancer recurrence after immediate reconstruction: patterns and significance[J]. \u003cem\u003ePlast. Reconstr. Surg.\u003c/em\u003e, \u003cb\u003e111\u003c/b\u003e(2): (2003). 712\u0026thinsp;\u0026ndash;\u0026thinsp;20; discussion 21\u0026thinsp;\u0026ndash;\u0026thinsp;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAKURAI, T. et al. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution[J]. \u003cem\u003eMed. Oncol.\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e (1), 481 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWEI C H et al. Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction[J]. \u003cem\u003eBreast J.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e (1), 10\u0026ndash;17 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHALLBECK, M. S. et al. Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM[J]. \u003cem\u003eAnn. Surg. Oncol.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e (5), 1318\u0026ndash;1326 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, nipple-sparing mastectomy, immediate breast reconstruction, patient-reported outcome measures","lastPublishedDoi":"10.21203/rs.3.rs-5276211/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5276211/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNipple-sparing mastectomy (NSM) has become increasingly common for breast cancer patients in China. There are limited data on its long-term clinical oncology and patient satisfaction. The objective of this study was to confirm the safety of clinical oncology and evaluate patient satisfaction with nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We retrospectively analyzed the clinical data of patients who underwent NSM followed by immediate breast reconstruction in our department. Clinicopathological data and follow-up information were collected and analyzed to evaluate the safety of NSM with immediate breast reconstruction. The BREAST-Q questionnaire was used to assess patient-reported outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 610 patients, including 624 with reconstructed breasts, were included in the study. Our results revealed that factors such as age\u0026thinsp;\u0026gt;\u0026thinsp;42 years, BMI\u0026thinsp;\u0026gt;\u0026thinsp;24 kg/m2, periareolar incisions, reconstruction with implants and acellular dermal matrix (ADM) with or without serratus anterior were independent risk factors for short-term complications after NSM with IBR. We utilized a column chart and calibration curve to illustrate the factors affecting the occurrence of short-term postoperative complications. The overall survival (OS) of all patients was 98.7%, and nipple‒areolar complex (NAC) recurrence did not impair patient survival. The 10-year survival rate and distant metastasis-free survival (DMFS) rate of the 4 patients who experienced NAC recurrence were 100%. The 10-year OS for patients without NAC recurrence was 96.0% (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and the DMFS rate was 89.4% (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Most patients were satisfied with the aesthetic outcome (\u0026gt;\u0026thinsp;90%), and nipple sensation was reported in 41.0% of patients, 8.3% of whom had normal sensation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNSM with immediate breast reconstruction yields favorable aesthetic outcomes, high patient satisfaction, and reliable oncological safety.\u003c/p\u003e","manuscriptTitle":"Clinical feature and patient-report outcome of nipple-sparing mastectomy with immediate breast reconstruction: a eighteen-year cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 16:11:46","doi":"10.21203/rs.3.rs-5276211/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-17T04:33:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-13T18:13:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-09T17:03:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183125281254729440668384945374209582790","date":"2024-12-18T07:48:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116160477189058535895644837780910856683","date":"2024-11-19T07:39:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252137891123842279135491418417881604243","date":"2024-11-19T06:21:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-14T05:52:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-09T19:37:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-07T15:56:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-04T07:23:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-16T13:19:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4033b34-a70e-4492-aec0-22e385968d7c","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":40260964,"name":"Health sciences/Oncology/Cancer"},{"id":40260965,"name":"Health sciences/Oncology/Surgical oncology"},{"id":40260966,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2025-03-31T07:45:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 16:11:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5276211","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5276211","identity":"rs-5276211","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}