title: Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?
abstract: Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM.
  
  
  
  Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed.
  
  
  
  One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis.
  
  
  
  Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM.
authors.affiliation: Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Durham, NC.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bahl
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Pien
authors.affiliation: Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Buretta
authors.affiliation: Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, NC.
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
authors.affiliation: Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.affiliation: Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Durham, NC.
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
authors.affiliation: Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC. Electronic address: scott.hollenbeck@duke.edu.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Hollenbeck
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology; D009558:Nipples / Q000098:blood supply / Q000473:pathology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016037:Single-Blind Method; D012867:Skin / Q000098:blood supply / Q000473:pathology