by Odom, Elizabeth B.;
Parikh, Rajiv P.; Um, Grace; Kantola, Simone W.; Cyr, Amy E.; Margenthaler,
Julie A.; Tenenbaum, Marissa M.; Myckatyn, Terence M.
Background:
Nipple-sparing mastectomy offers several advantages for women seeking
postmastectomy breast reconstruction, but compromised skin and nipple perfusion
may lead to skin and nipple necrosis. It is unclear whether the incisional
approach contributes to these complications; therefore, the purpose of this
study was to compare the impact of incision type on outcomes in patients
undergoing nipple-sparing mastectomy. Methods: This is a prospective cohort
study of patients undergoing nipple-sparing mastectomy with prosthetic breast
reconstruction through an inframammary fold versus a lateral radial incision.
Skin and nipple perfusion as represented by fluorescence intensity, mammometric
parameters, patient-reported outcomes, and clinical outcomes were analyzed and
compared for the two cohorts, and multivariable logistic regression models were
performed to evaluate the effects of covariates on outcomes. Results:
Seventy-nine patients were studied: 55 in the inframammary fold cohort and 24
in the lateral radial cohort. The inframammary fold group had significantly
less fluorescence intensity to the inferior (21.9 percent versus 36.9 percent;
p = 0.001) and lateral portions of breast skin (23.1 percent versus 40.7
percent; p = 0.003) after reconstruction. Decreased fluorescence intensity was
associated with smoking, decreased mean arterial pressure, and greater specimen
weight. Postreconstruction breast volumes were increased over preoperative
volumes in the inframammary fold group (38.3 percent) versus the lateral radial
(31.2 percent) group; however, patients with a lateral radial incision had a
greater increase in satisfaction with their breasts and psychosocial
well-being. Conclusions: There are significant differences in patient-reported
outcomes and final breast volumes based on the incisional approach to
nipple-sparing mastectomy. These data can be used to guide providers and
counsel patients considering nipple-sparing mastectomy with prosthetic
reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
