title: The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction.
abstract: BACKGROUND
  The indications for nipple-sparing mastectomy (NSM) are broadening as more breast surgeons appreciate the utility of preserving the nipple-areolar complex. A number of incision locations are available to the mastectomy surgeon, including inframammary, lateral and periareolar approaches. The present study investigated the effect of these three incisions on reconstructive outcomes; specifically, nipple necrosis.
  
  
  METHODS
  A single-centre, retrospective review of 37 breast NSM reconstructions treated with immediate tissue expander reconstruction with acellular dermis between 2007 and 2008 was performed. The primary outcome was the incidence of nipple necrosis associated with periareolar, lateral and inframammary incisions. Secondary outcomes were the effects of radiation, chemotherapy and breast size on nipple necrosis.
  
  
  RESULTS
  Thirty-seven breast procedures performed on 20 patients were included in the present study. Periareolar incisions were used in 21 cases, lateral incisions in 14 and inframammary incisions in two. The periareolar incision was associated with a significantly higher incidence of nipple necrosis compared with lateral or inframammary incisions (38.1% versus 6.3%, P=0.028). Patients receiving breast radiation (45.5% versus 15.4%, P=0.066) and those with larger breast size (540.4 g versus 425.7 g, P=0.130) also demonstrated a modest trend toward an increased rate of nipple necrosis.
  
  
  CONCLUSIONS
  The periareolar incision results in a higher rate of nipple necrosis following NSM and immediate tissue expander breast reconstruction. Using the lateral or inframammary incision reduces the incidence of nipple necrosis and may help improve overall reconstructive and cosmetic outcomes.
authors.affiliation: Division of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Rawlani
authors.forename: Julia
authors.initials: J
authors.lastname: Fiuk
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Johnson
authors.forename: Donald W
authors.initials: DW
authors.lastname: Buck
authors.forename: Elliot
authors.initials: E
authors.lastname: Hirsch
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
authors.forename: Seema
authors.initials: S
authors.lastname: Khan
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.forename: John Ys
authors.initials: JY
authors.lastname: Kim