Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction
Soeun Park,
Changik Yoon,
Soong June Bae,
Chihwan Cha,
Dooreh Kim,
Janghee Lee,
Sung Gwe Ahn,
Tai Suk Roh,
Young Seok Kim,
Joon Jeong
Affiliations
Soeun Park
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Surgery, CHA Ilsan Medical Center, CHA University, Goyang, South Korea
Changik Yoon
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Soong June Bae
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Chihwan Cha
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Dooreh Kim
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Janghee Lee
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Sung Gwe Ahn
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Tai Suk Roh
Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Young Seok Kim
Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Joon Jeong
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Corresponding author. Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-Gu, Seoul, 06273, South Korea.
Background: Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR. Methods: We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis. Results: Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis. Conclusions: Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.
