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Is There a Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis.

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Nipple-sparing mastectomy incision choice impacts outcomes. Periareolar incisions show the highest necrosis rates, while inframammary fold incisions offer an acceptable complication profile and are increasingly popular for breast cancer surgery.

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Area of Science:

  • Oncology
  • Plastic Surgery
  • Surgical Techniques

Background:

  • Nipple-sparing mastectomy (NSM) incidence is increasing.
  • Optimal incision type for NSM remains unproven.
  • Focus on nipple-areola complex (NAC) viability and reconstruction is crucial.

Purpose of the Study:

  • Systematically evaluate NSM incision locations.
  • Determine the efficacy of different incision types.
  • Analyze rates of NAC necrosis and reconstructive outcomes.

Main Methods:

  • Systematic literature review following PRISMA guidelines.
  • Meta-analysis of pooled data from 51 studies (9975 NSMs).
  • Categorization of 32 incision variations into six groups.

Main Results:

  • Overall partial NAC necrosis: 4.62%, total NAC necrosis: 2.49%.
  • Periareolar incisions had the highest NAC necrosis rate (18.10%).
  • Endoscopic (4.90%) and mastopexy/prior scar/reduction (5.79%) incisions showed lowest necrosis rates, followed by inframammary fold (6.82%).

Conclusions:

  • Periareolar incisions are associated with the highest NAC necrosis due to compromised blood supply.
  • Inframammary fold incisions are now most common, demonstrating an acceptable complication profile for NSM.