title: Nipple Sparing Mastectomy in Patients With Prior Breast Scars: Is It Safe?
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) preserves the native skin envelope, including the nipple-areolar skin, and has significant benefits including improved aesthetic outcome and psychosocial well-being. Patients with prior breast scars undergoing NSM are thought to be at increased risk for postoperative complications, such as skin and/or nipple necrosis. This study describes our experience performing NSM in patients who have had prior breast surgery and aims to identify potential risk factors in this subset of patients.
  
  
  METHODS
  A retrospective review of all patients undergoing nipple sparing mastectomy at The University of Utah from 2005 to 2011 was performed. Fifty-two patients had prior breast scars, for a total of 65 breasts. Scars were categorized into 4 groups depending on scar location: inframammary fold, outer quadrant, periareolar, and circumareolar. Information regarding patient demographics, social and medical history, treatment intent, and postoperative complications were collected and analyzed.
  
  
  RESULTS
  Eight of the 65 breasts (12%) developed a postoperative infection requiring antibiotic treatment. Tobacco use was associated with an increased risk of infection in patients with prior breast scars (odds ratio [OR], 7.95; 95% confidence interval [CI], 1.37-46.00; P = 0.0206). There was a 13.8% rate of combined nipple and skin flap necrosis and receipt of chemotherapy (OR, 5.00; CI, 1.11-22.46; P = 0.0357) and prior BCT (OR, 12.5; CI, 2.2-71.0; P = 0.004) were found to be associated with skin flap or NAC necrosis.
  
  
  CONCLUSIONS
  Nipple-sparing mastectomy is a safe and viable option for patients with a prior breast scar. Our results are comparable to the published data in patients without a prior scar. Caution should be exercised with patients who have a history of tobacco use or those requiring chemotherapy because these patients are at increased risk for infection and NAC/skin flap necrosis, respectively, when undergoing NSM in the setting of a prior breast scar.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, †Department of Surgery, ‡Division of Epidemiology, Department of Internal Medicine, §Department of Biology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Joshua
authors.initials: J
authors.lastname: Olson
authors.forename: Layla Ann
authors.initials: LA
authors.lastname: Anderson
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.forename: Min-Min
authors.initials: MM
authors.lastname: Zhang
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult