Background: The incidence of
nipple-sparing mastectomy is rising, but no single incision type has been
proven to be superior. This study systematically evaluated the rate and
efficacy of various nipple-sparing mastectomy incision locations, focusing on
nipple-areola complex necrosis and reconstructive method.
Methods: A systematic literature review
was performed according to the Preferred Reporting Items for Systematic Review
and Meta-Analyses guidelines identifying studies on nipple-sparing mastectomy
where incision type was described. Pooled descriptive statistics meta-analysis
of overall (nipple-areola complex) necrosis rate and nipple-areola complex
necrosis by incision type was performed.
Results: Fifty-one studies (9975
nipple-sparing mastectomies) were included. Thirty-two incision variations were
identified and categorized into one of six groups: inframammary fold, radial,
periareolar, mastopexy/prior scar/reduction, endoscopic, and other. The most
common incision types were inframammary fold [3634 nipple-sparing mastectomies
(37.8 percent)] and radial [3575 nipple-sparing mastectomies (37.2 percent)].
Meta-analysis revealed an overall partial nipple-areola complex necrosis rate
of 4.62 percent (95 percent CI, 3.14 to 6.37 percent) and a total nipple-areola
complex necrosis rate of 2.49 percent (95 percent CI, 1.87 to 3.21 percent).
Information on overall nipple-areola complex necrosis rate by incision type was
available for 30 of 51 studies (4645 nipple-sparing mastectomies). Periareolar
incision had the highest nipple-areola complex necrosis rate (18.10 percent).
Endoscopic and mastopexy/prior scar/reduction incisions had the lowest rates of
necrosis at 4.90 percent and 5.79 percent, respectively, followed by the
inframammary fold incision (6.82 percent). The rate of single-stage implant
reconstruction increased during this period. Conclusions: For nipple-sparing mastectomy, the periareolar
incision maintains the highest necrosis rate because of disruption of the
nipple-areola complex blood supply. The inframammary fold incision has become
the most popular incision, demonstrating an acceptable complication profile.
