by Salibian, Ara A.; Bekisz, Jonathan M.; Frey, Jordan D.;
Thanik, Vishal D.; Levine, Jamie P.; Karp, Nolan S.; Choi, Mihye
Plastic and Reconstructive Surgery: December 2021
- Volume 148 - Issue 6 - p 1173-1185
Background:
Incision planning is a critical factor in nipple-sparing
mastectomy outcomes. Evidence on optimal incision patterns in patients
undergoing nipple-sparing mastectomy and immediate microvascular breast
reconstruction is lacking in the literature.
Methods:
A single-institution retrospective review was performed of
consecutive patients undergoing nipple-sparing mastectomy and immediate
microvascular autologous reconstruction from 2007 to 2019. Outcomes—including
major mastectomy flap necrosis, full nipple-areola complex necrosis, and any
major ischemic complication of the skin envelope—were compared among incision
types. Multivariable logistic regression identified factors associated with major
ischemic complication.
Results:
Two hundred seventy-nine reconstructions (163 patients) were
identified, primarily using internal mammary recipient vessels (98.9 percent).
Vertical incisions were used in 139 cases; inframammary, in 53; lateral radial,
in 51; and inverted-T, in 35. Thirty-two cases (11.5 percent) had major
mastectomy flap necrosis, 11 (3.9 percent) had full nipple-areola complex
necrosis, and 38 (13.6 percent) had any major ischemic complication.
Inframammary incisions had higher rates of major ischemic complication (25
percent) than vertical (5.8 percent; p < 0.001) and lateral radial
(7.8 percent; p = 0.032) incisions. Inverted-T incisions also had
higher rates of major ischemic complication (36.1 percent) than both vertical (p <
0.001) and lateral radial (p = 0.002) incisions. Inframammary incisions
(OR, 4.382; p = 0.002), inverted-T incisions (OR, 3.952; p =
0.011), and mastectomy weight (OR, 1.003; p < 0.001) were
independently associated with an increased risk of major ischemic complication.
Inframammary incisions with major ischemic complication demonstrated
significantly higher body mass index, mastectomy weight, and flap weight
compared to those without.
Conclusions:
Inframammary and inverted-T incisions are associated with a
higher risk of major ischemic skin envelope complications after nipple-sparing
mastectomy and immediate microvascular breast reconstruction. Radial incisions
can be considered to optimize recipient vessel exposure without compromising
perfusion.
