Influence of the Site of Skin Incision on the Circulation in the Nipple-Areola Complex After Subcutaneous Mastectomy in Breast Cancer

Abstract

Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex and in the surrounding skin. Sixty-nine patients with invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a "lazy-S"-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two or three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (p < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.

Influence of Radiation Therapy on Skin Circulation in the Breast after Breast Conservative Surgery

“…With laser Doppler fluxmetry, but not with fluorescein flowmetry, a two to three times higher skin circulation was found in the nipple-areola complex compared with the areas 2 crn above and below the border of the areola. These results are in concordance with earlier findings of a twice as high skin circulation in the nipple-areola complex compared with the surrounding areas, as measured by laser Doppler fluxmetry, and a 20% higher skin circulation below the complex compared with that above it, in both an intact breast and after subcutaneous mastectomy (16). There are several explanations for this discrepancy between the methods.…”

Reducing the Risk of Nipple Necrosis: Technical Observations in 340 Nipple-sparing Mastectomies

“…Examining the blood supply to the NAC using images from breast MRIs, the vascularization of the lower breast skin appears less robust than what is seen in the upper breast. Proano and Perbeck who measured skin circulation in 69 patients using laser Doppler and fluorescein flometry lend clinical support to this observation . They compared skin circulation in patients having either an inframammary fold incision or a lateral lazy S incision.…”

Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

“… 14 , 15 There is evidence that the incision technique can influence blood circulation over the superficial skin. 16 , 17 Jensen et al 18 described the concept of “degrees of perfusion” of the nipple-areolar complex as key in determining rates of nipple necrosis. The choice of incision type in combination with other patient factors including body mass index, smoking, and radiotherapy affect the rate of skin necrosis and overall complications.…”