<p>The Role of Sharp Dissection in Nipple-Sparing Mastectomy: A Safe Procedure with No Necrosis of the Nipple-Areolar Complex</p>

Abstract

Background: Nipple-sparing mastectomy (NSM) is becoming increasingly accepted as a treatment for breast disease; however, nipple-areolar complex (NAC) necrosis, a frequent severe postoperative complication, inhibits the popularity of this procedure. This study reports the technical aspects and short-term postoperative outcomes of NSM. Methods: A single-center, retrospective review of 110 patients treated with NSM at our institution from November 2015 to September 2018 was performed. The primary outcome was the incidence of NAC necrosis. Results: A total of 130 NSMs performed on 110 patients were included in our study. Median patient age was 42 years. We performed a sharp dissection by using a scalpel, raising 3-5 mm thick flaps, and continuing onto the undersurface of the NAC. None of the 110 patients appeared to have NAC necrosis or mastectomy skin flap necrosis. However, discoloration or ischemia of the NAC with eschar formation presented between postoperative days 3 and 7 in six nipples; four nipples were ischemic, and two were discolored. No infection was detected in any of the 110 patients. All NACs were intact after an average follow-up of 30 months, and no local or systemic recurrence was detected in those breast cancer cases. Conclusion: NSM can be safely performed in properly selected patients. Nipple necrosis was avoided using a special surgical technique, and other complications occurred at an acceptable rate.

Adenectomia mamária para o tratamento do câncer de mama inicial: importância da avaliação da margem retroareolar e da remoção dos ductos intrapapilares

“…Por esse motivo, as incisões mediais devem ser, preferencialmente, evitadas. 34 Yang et al 126 , realizando técnica semelhante à descrita nesta tese, em 130 AM de 110 pacientes, demonstraram que a retirada dos ductos intrapapilares com bisturi, deixando uma espessura de 3,0 a 5,0 mm de retalho, não acarretou maior risco de necrose. A avaliação da margem retroareolar pode ser usada para predizer o envolvimento tumoral da papila em pacientes submetidos à AMT, no entanto, considera-se que essa abordagem pode oferecer limitação, ocasionando falsonegativos.…”