Technical considerations in nipple-sparing mastectomy: 82 consecutive cases without necrosis.
BACKGROUND
Even without comparative trials, nipple-sparing mastectomy (NSM) is gaining traction in the treatment of established breast cancer and in the prophylactic setting. As yet, there are no established techniques that are universally applied to NSM. Herein we describe our surgical approach.


METHODS
All mastectomies performed by a single surgeon (AJS). Reconstructions performed included synthetic implants, deep inferior epigastric (DIEP) and gluteal artery perforator flaps (GAP). A lateral incision (12.1%) and a 6:00 radial incision (87.9%) were used in all patients. The areola was elevated just beneath the deep dermis and ductal tissue within the nipple papilla was "cored".


RESULTS
Fifty-eight patients underwent 82 NSMs for both cancer and prophylaxis. No patient developed necrosis of the nipple-areola complex (NAC). Minor skin-edge necrosis not involving the NAC occurred in 2 patients. Four patients developed a hematoma, 2 requiring re-operation. One patient required re-operation to correct a vein problem. There were no flap losses.


CONCLUSIONS
NSM can be performed with a minimal incidence of skin-flap related complications. In our hands, radial incisions perform well in this regard. Indications for NSM and the optimal technique are yet to be determined.
Stolier
Alan J
AJ
Department of Surgery, Tulane University, 2525 Severn Ave., Metairie, New Orleans, LA 70002, USA. astolier@tulane.edu
Sullivan
Scott K
SK
Dellacroce
Frank J
FJ
D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000556:secondary / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009336:Necrosis; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012867:Skin / Q000033:anatomy & histology; D013524:Surgical Flaps; D016896:Treatment Outcome