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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Nipple-sparing mastectomy: technical aspects and aesthetic outcomes
Hunter R Moyer1, Bahair Ghazi, Jarrod R Daniel
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. hmoyer@emory.edu
Annals of Plastic Surgery
|April 26, 2012
Summary
Nipple-sparing mastectomy (NSM) offers better aesthetic outcomes in breast reconstruction. While partial nipple necrosis can occur, especially with circumareolar incisions, most cases heal well, preserving nipple aesthetics.
Area of Science:
- Plastic Surgery
- Oncology
- Breast Reconstruction
Background:
- Nipple-sparing mastectomy (NSM) is a growing technique for immediate breast reconstruction.
- This study examines the technical aspects and aesthetic results of NSM.
Purpose of the Study:
- To evaluate the aesthetic outcomes of nipple-sparing mastectomy (NSM) compared to skin-sparing mastectomy.
- To describe technical refinements in NSM, including incision types and nipple positioning.
Main Methods:
- A prospective review of 40 NSMs performed between 2009 and 2010.
- Postoperative photographs were graded to compare aesthetic outcomes (symmetry, inframammary fold, volume, contour, nipple).
- Analysis of nipple necrosis incidence based on different incision types.
Main Results:
- Partial nipple necrosis occurred in 37.5% of breasts, with higher rates for radial/circumareolar incisions (75%).
- Most partial nipple necrosis cases healed with local wound care.
- Nipple aesthetic outcomes were significantly better following NSM compared to reconstruction after skin-sparing mastectomy (P=0.01).
Conclusions:
- High incidence of partial nipple necrosis is linked to circumareolar incisions.
- Superficial nipple necrosis generally heals well.
- Nipple preservation in NSM significantly enhances aesthetic results in immediate breast reconstruction.