Assessment of incision types, risk factors, and complication rates in nipple and skin-sparing mastectomy

Abstract

Introduction: The incidence of breast cancer in the female population of reproductive age is rising. Surgery is the primary approach, and other treatment options can be adopted in certain circumstances. In the surgical field, lately, there has been a growing interest for nipple–skin-sparing mastectomy (NSSM). This study aims to emphasize the effect of incision types and patient characteristics (demographics, concomitant disease, smoking, history of radiotherapy, and chemotherapy) on complication rates. Patients and Methods: The subjects included 184 breasts in 92 female patients who underwent the NSSM procedure at our clinic from January 2010 to May 2019. Patients who underwent bilateral NSSM and immediate reconstruction with prosthesis were included in the study. Results: The most commonly used incision pattern was the inverted T-scar. Seven patients who had a contralateral prophylactic mastectomy (7.6%) were found to have atypical proliferative lesions or occult breast carcinoma in the clinically healthy contralateral breast on pathological examination. Complications were seen in 36 patients (39.1%). Skin–nipple–areolar complex necrosis was the most frequent complication. A previous history of radiation therapy was associated with higher rates of complications. Conclusion: NSSM and immediate single-stage implant reconstruction is a procedure with high morbidity and complication rates. The incision type and smoking have the main effect on complication rates. Although most complications are manageable, the surgical approach and patient-related risk factors should be taken into consideration for avoiding them.