Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

Abstract

Background Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR. Methods We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis. Results Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis. Conclusions Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.

The iBAG study—a milestone?

“…There are several studies confirming the inframammary fold incision as a safe and cosmetically perfect incisional access. 3 The visibility of the retroareolar region and the exact excision of the breast gland and the ducts is feasible in experienced hands after a certain learning curve.…”

“…In general, we are the proponents and advocates for prepectoral implant based breast reconstruction after nipple-sparing mastectomy and promote the further implementation of this method 4 -but iBAG a milestone? Roland Reitsamer 1 Florentia Peintinger 2,3 Frederike Klaassen-Federspiel 1 Andreas Sir 1 1 Department of Senology, University Hospital Salzburg,…”

Immediate Reconstruction of Large Ptotic Breasts following Vertical Reduction Pattern Nipple-Sparing Mastectomy

“…To prove the safety of this procedure, it is necessary to compare the incidence of NAC necrosis in this procedure with that in the conventional superolateral oblique incision approach. In a recent study of 53 patients who underwent NSM via the conventional superolateral radial incision, Park et al [ 19 ] observed nipple necrosis in 9 (17.0%) patients. Further, Algaithy et al [ 20 ] reported a 16.2% incidence of NAC necrosis among 37 patients who received NSM via a superolateral incision.…”

Impact of Body Composition on Postoperative Outcomes in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction

“…Nipple-areolar complex (NAC) ischemia and necrosis are common complications after nipple-sparing mastectomy (NSM) with a prevalence range of 0–48%, mostly 10–15% [ 1 , 2 , 3 , 4 ]. Several risk factors for NAC-related complications after a mastectomy with breast reconstruction (BR) have been identified, including obesity, ptosis, large breast weight and volume, prior radiotherapy history, and incision type [ 1 , 5 , 6 , 7 , 8 ], among which, obesity is a well-known risk factor [ 9 , 10 , 11 ]. Obesity is evaluated using body mass index (BMI), which reflects only body height and weight but does not reflect body composition, such as muscle and adipose tissue compositions.…”