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Delay techniques for nipple-sparing mastectomy: A systematic review
Laurel S Karian1, Paul J Therattil1, Philip D Wey1
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|January 2, 2017
Summary
Nipple-sparing mastectomy (NSM) delay procedures offer a good safety profile for preventing nipple-areolar complex (NAC) and flap necrosis. These staged approaches may also improve retroareolar biopsy accuracy before NSM.
Area of Science:
- Surgical Oncology
- Breast Surgery
- Plastic Surgery
Background:
- Nipple-sparing mastectomy (NSM) carries risks of nipple-areolar complex (NAC) and mastectomy flap necrosis.
- Delay procedures are emerging techniques to mitigate these NSM complications.
- These methods can be combined with a preliminary retroareolar biopsy.
Purpose of the Study:
- To systematically review literature on nipple-areolar complex (NAC) and mastectomy flap delay techniques.
- To evaluate the safety and efficacy of staged procedures prior to nipple-sparing mastectomy (NSM).
Main Methods:
- Systematic literature search of PubMed and Cochrane databases (1975-2016).
- Inclusion criteria: studies on patients undergoing delay procedures before NSM with objective outcomes.
- Keywords: 'nipple sparing mastectomy' AND ('delay' OR 'stage' OR 'staged').
Main Results:
- Five studies involving 101 patients met the inclusion criteria.
- Partial NAC necrosis occurred in 8.9% of patients; mastectomy flap necrosis in 7.9%.
- Retroareolar biopsy was positive in 6.9% of patients across three studies.
Conclusions:
- Delay procedures for NSM demonstrate a favorable safety profile.
- Considered for patients with risk factors like prior radiation, smoking, or breast scars.
- Facilitates accurate retroareolar biopsy, guiding NAC management during NSM and avoiding frozen section limitations.
