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Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Frey, Jordan D. M.D.; Salibian, Ara A. M.D.; Levine, Jamie P. M.D.; Karp, Nolan S. M.D.; Choi, Mihye M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 826e-835e
doi: 10.1097/PRS.0000000000004969
Breast: Original Articles
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Background: Nipple-sparing mastectomy allows for preservation of the entire nipple-areola complex using various incision patterns. Reconstructive trends and overall risk associated with these diverse nipple-sparing mastectomy incisions have yet to be fully elucidated.

Methods: All nipple-sparing mastectomies from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar.

Results: A total of 1207 nipple-sparing mastectomies were included for final analysis. Of these, 638 (52.9 percent) used an inframammary fold incision, 294 (24.4 percent) used a lateral radial incision, 161 (13.3 percent) used a vertical radial incision, 60 (5.0) used a Wise pattern incision, 35 (2.9 percent) used a previous incision, and 19 (1.6 percent) used a periareolar incision. The groups were heterogeneous and differed significantly with regard to various factors, including age (p < 0.001), body mass index (p < 0.001), reconstruction modality (p < 0.001), and others. In crude multivariate logistic regression analysis, vertical radial (16.1 percent) and inframammary fold incisions (21.0 percent) were associated with lower overall complication rates. In a reduced multivariate logistic regression model, inframammary fold incisions (p = 0.001) emerged as significantly protective of overall complications after controlling all variables.

Conclusions: Nipple-sparing mastectomy may be safely performed using various mastectomy incisions, each with unique advantages and limitations. Overall, inframammary fold incisions appear to be associated with the lowest risk, whereas Wise pattern incisions may increase risk.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

New York, N.Y.

From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.

Received for publication January 18, 2018; accepted May 8, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Mihye Choi, M.D., New York University Langone Health, 305 East 47th Street, Suite 1A, New York, N.Y. 10017, mihye.choi@nyumc.org

Copyright © 2018 by the American Society of Plastic Surgeons