by Frey, Jordan
D.; Salibian, Ara A.; Karp, Nolan S.; Choi, Mihye
Background:
Reconstructive trends and outcomes for nipple-sparing mastectomy continue to be
defined. The graduated impact of breast size and mastectomy weight remains
incompletely evaluated. Methods: All patients undergoing nipple-sparing
mastectomy from 2006 to June of 2016 were identified. Demographics and outcomes
were analyzed and stratified by mastectomy weight of 800 g or higher (large
group), between 799 and 400 g (intermediate group), and less than 400 g (small
group). Results: Of 809 nipple-sparing mastectomies, 66 (8.2 percent) had
mastectomy weights of 800 g or higher, 328 (40.5 percent) had mastectomy
weights between 799 and 400 g, and 415 nipple-sparing mastectomies (51.3
percent) had mastectomy weights less than 400 g. Nipple-sparing mastectomies in
the large group were significantly more likely to be associated with major
mastectomy flap necrosis (p = 0.0005), complete nipple-areola complex necrosis
(p < 0.0001), explantation (p < 0.0001), cellulitis treated with oral (p
= 0.0008) and intravenous (p = 0.0126) antibiotics, abscess (p = 0.0254), and
seroma (p = 0.0126) compared with those in the intermediate group. Compared
with small nipple-sparing mastectomies, patients in the large group had greater
major mastectomy flap necrosis (p < 0.0001), complete (p < 0.0001) and
partial (p = 0.0409) nipple-areola complex necrosis, explantation (p <
0.0001), cellulitis treated with oral (p < 0.0001) and intravenous (p <
0.0001) antibiotics, abscess (p = 0.0119), and seroma (p < 0.0001). Patients
in the intermediate group were more likely to experience major (p < 0.0001)
and minor (p < 0.0001) mastectomy flap necrosis, complete (p = 0.0015) and
partial (p < 0.0001) nipple-areola complex necrosis, cellulitis treated with
oral antibiotics (p = 0.0062), and seroma (p = 0.0248) compared with those
undergoing small nipple-sparing mastectomies. Larger mastectomy weights were
significant predictors of complications on logistic regression analysis.
Conclusion: Reconstructive and ischemic complications in nipple-sparing
mastectomy are progressively greater as mastectomy weight and breast size
increase. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
