title: Nipple-sparing mastectomy: technical aspects and aesthetic outcomes.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) is increasingly used to improve the results of immediate breast reconstruction. Technical aspects and aesthetic outcomes of this procedure are examined.
  
  
  METHODS
  A study of a prospective institutional database of all cases of NSM between 2009 and 2010 was performed. Aesthetic outcomes (symmetry, inframammary fold, volume, contour, and nipple) are compared with patients undergoing skin-sparing mastectomy and immediate breast reconstruction by grading postoperative photographs. Technical refinements in incision types and nipple positioning are described.
  
  
  RESULTS
  Twenty-six patients underwent 40 NSMs during the study period. Partial nipple necrosis occurred in 15 breasts (37.5%); of them, 14 healed uneventfully with local wound care, and 1 patient required delayed nipple reconstruction. Nipple necrosis by incision type was radial/circumareolar in 6 of 8 (75%) patients; radial, 3 of 9 (33.3%); inframammary fold, 6 of 22 (27.3%); and vertical, 0 of 1 (0%). The nipple aesthetic outcome was significantly better for NSM compared with nipple reconstruction after skin-sparing mastectomy (P = 0.01).
  
  
  CONCLUSIONS
  The incidence of partial nipple necrosis was high and was related to circumareolar incisions. Most cases of nipple necrosis are superficial and heal uneventfully. Preservation of the nipple improves the aesthetic outcome of immediate breast reconstruction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. hmoyer@emory.edu
authors.forename: Hunter R
authors.initials: HR
authors.lastname: Moyer
authors.forename: Bahair
authors.initials: B
authors.lastname: Ghazi
authors.forename: Jarrod R
authors.initials: JR
authors.lastname: Daniel
authors.forename: Renee
authors.initials: R
authors.lastname: Gasgarth
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D015588:Observer Variation; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome