Nipple-sparing mastectomy with periareolar incision and two-stage reconstruction: Initial analysis of 31 cases

Surgical treatment of breast cancer has changed considerably over the past four decades, culminating in the substitution of conservative approaches for Halsted's paradigm from 1894. In parallel, many breast reconstruction techniques have been proposed for patients requiring mastectomy with loss of the nipple-areola complex (NAC). Myocutaneous flaps were once the most common form of reconstruction, but recently the use of implants and nipple-sparing mastectomy (NSM) in one or two stages has gained popularity. In this descriptive and cross-sectional study, we evaluated a sample of 31 NSM procedures with periareolar incision and two-stage reconstruction (tissue expander followed by implant) conducted between 2013 and 2017, with emphasis on the rate of complications after at least 3 months of follow-up, local disease control and cosmesis measured on the Harvard scale. Five complications (16%) were observed, all of which related to the first stage: seroma (n = 1; 3.2%), treated with needle aspiration, NAC necrosis (n = 3; 9.6%), one case of which required debridement, and dehiscence (n = 1; 3.2%), treated with resuture. Cosmesis was classified as excellent by the surgeon in 96.8% (n = 27). At the time of writing, no local recurrence had been observed. In conclusion, NSM with periareolar incision and two-stage reconstruction was found to be technically feasible and associated with few complications and satisfactory esthetic outcomes.