by Willey, Shawna C.; Fan, Kenneth L.; Luvisa, Kyle;
Graziano, Francis D.; Lau, Stephanie H. Y.; Black, Cara K.; Song, David H.;
Pittman, Troy
Plastic and
Reconstructive Surgery: February 2020
- Volume 145 - Issue 2 - p 251e-262e
Background: The
authors refine their anatomical patient selection criteria with a novel
midclavicular-to–inframammary fold measurement for nipple-sparing mastectomy
performed through an inframammary approach.
Methods:
Retrospective review was performed of all nipple-sparing mastectomies performed
through an inframammary approach. Exclusion criteria included other mastectomy
incisions, staged mastectomy, previous breast operation, and autologous
reconstruction. Preoperative anatomical measurements for each breast, clinical
course, and specimen weight were obtained.
Results: One
hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not
sternal notch–to-nipple distance, was strongly correlated with
midclavicular-to–inframammary fold measurement on linear regression (R2 =
0.651; p < 0.001). Mastectomy weight was not correlated with ptosis.
Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4
percent) were nonoperative and nine (6.4 percent) were operative. Those with
mastectomy weights of 500 g or greater were nine times more likely to have
operative ischemic complications than those with mastectomy weights less than
500 g (p = 0.0048). Those with a midclavicular-to–inframammary fold measurement
of 30 cm or greater had a 3.8 times increased incidence of any ischemic
complication (p = 0.00547) and a 9.2 times increased incidence of operative
ischemic complications (p = 0.00376) compared with those whose
midclavicular-to–inframammary fold measurement was less than 30 cm.
Conclusions:
Breasts undergoing nipple-sparing mastectomy by means of an inframammary
approach with midclavicular-to–inframammary fold measurement greater than or
equal to 30 cm are at higher risk for having ischemic complications, warranting
consideration for a staged approach or other incision. The
midclavicular-to–inframammary fold measurement is useful for assessing the
entire breast and predicting the likelihood of ischemic complications in
inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
