title: Oncological and Surgical Outcomes After Nipple-Sparing Mastectomy: Do Incisions Matter?
abstract: While nipple-sparing mastectomy (NSM) for the treatment of breast cancer is becoming more accepted, technical aspects are still evolving. Data regarding risk factors contributing to complications after NSM are limited. This study evaluated technical aspects on outcomes of NSM.
  
  
  
  Review of our database identified 201 patients who had NSM during the period from January 2012 to June 2015. We compared the effect of operative techniques on surgical outcomes.
  
  
  
  A total of 351 NSM were performed in 201 patients. Mean patient age was 47 years. Inframammary (47 %) or periareolar (35 %) incisions were most frequent. Tumescence was used in 203 (58 %) NSM. Skin flaps were created using sharp dissection in 213 (61 %) and electrocautery in 138 (39 %) breasts. Nipple areola complex (NAC) necrosis was seen in 56 (16 %) breasts, of which 7 were severe (2 %). A higher rate of NAC complications was seen with periareolar incisions (p = 0.02). Sharp dissection did not result in significant rates of flap necrosis compared with electrocautery. Ten patients (3 %) had a positive anterior/deep margin, of which 7 (64 %) had an inframammary approach. Twenty-two (11 %) patients had an infection that required intravenous antibiotics. Fourteen (7 %) patients had implant loss. Dissection technique was not associated with implant loss (p = 1.0) or infection (p = 0.84). Forty-two (12 %) patients had radiation and seven (16 %) required implant removal.
  
  
  
  NSM has an acceptable complication rate. NAC necrosis requiring excision or implant loss is rare. Postmastectomy radiation is a significant risk factor for implant loss. Inframammary incisions have fewer ischemic complications but may result in tumor-involved margins.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Donovan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Attiya P
authors.initials: AP
authors.lastname: Harit
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Chung
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Bao
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. farin.amersi@cshs.org.
authors.forename: Farin
authors.initials: F
authors.lastname: Amersi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local; D009558:Nipples / Q000473:pathology*; D059351:Organ Sparing Treatments / Q000009:adverse effects; D000072036:Prophylactic Mastectomy; D012189:Retrospective Studies; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult