by Frey, Jordan D.;
Salibian, Ara A.; Levine, Jamie P.; Karp, Nolan S.; Choi, Mihye
Background:
Nipple-sparing mastectomy allows for preservation of the entire nipple-areola
complex using various incision patterns. Reconstructive trends and overall risk
associated with these diverse nipple-sparing mastectomy incisions have yet to
be fully elucidated.
Methods: All
nipple-sparing mastectomies from 2006 to 2017 were identified; outcomes were
stratified by type of mastectomy incision: lateral or vertical radial,
inframammary fold, Wise pattern, previous, and periareolar.
Results: A
total of 1207 nipple-sparing mastectomies were included for final analysis. Of
these, 638 (52.9 percent) used an inframammary fold incision, 294 (24.4
percent) used a lateral radial incision, 161 (13.3 percent) used a vertical
radial incision, 60 (5.0) used a Wise pattern incision, 35 (2.9 percent) used a
previous incision, and 19 (1.6 percent) used a periareolar incision. The groups
were heterogeneous and differed significantly with regard to various factors,
including age (p < 0.001), body mass index (p < 0.001), reconstruction
modality (p < 0.001), and others. In crude multivariate logistic regression
analysis, vertical radial (16.1 percent) and inframammary fold incisions (21.0
percent) were associated with lower overall complication rates. In a reduced
multivariate logistic regression model, inframammary fold incisions (p = 0.001)
emerged as significantly protective of overall complications after controlling
all variables.
Conclusions:
Nipple-sparing mastectomy may be safely performed using various mastectomy
incisions, each with unique advantages and limitations. Overall, inframammary
fold incisions appear to be associated with the lowest risk, whereas Wise
pattern incisions may increase risk. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
III.
