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Updated: Jan 28, 2026
13:35
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
4.1K
Surgical delay may extend the indications for nipple-sparing mastectomy: A multicentric study
Emanuele Zarba Meli1, Federico Cattin2, Annalisa Curcio3
1Department of Surgery, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00199, Rome, Italy.
Summary
Surgical delay (SD) before nipple-sparing mastectomy (NSM) is a safe technique that reduces complications. This method expands the possibility of performing NSM in women with higher risk factors, achieving excellent aesthetic outcomes.
Area of Science:
- Oncology
- Plastic and Reconstructive Surgery
- Breast Surgery
Background:
- Nipple-sparing mastectomy (NSM) is oncologically safe but carries risks of nipple-areola complex (NAC) or skin flap necrosis.
- Surgical delay (SD) techniques aim to mitigate these complications and broaden NSM indications.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical delay (SD) in nipple-sparing mastectomy (NSM).
- To assess complication rates and aesthetic outcomes of SD followed by NSM.
Main Methods:
- Retrospective analysis of 88 patients undergoing SD for NSM across four Italian Breast Centers (2014-2017).
- SD involved periareolar or hemi-batwing incision with NAC dissection, followed by NSM after 2-3 weeks.
- Reconstruction utilized direct-to-implant (DTI) or tissue expander (TE) methods.
Main Results:
- SD had mild complications in 7.9% of cases.
- NSM was performed in 85 cases; 3.4% required conversion to skin-sparing mastectomy due to positive retroareolar biopsy.
- Post-NSM complications occurred in 9.4% (including one total NAC necrosis, one skin flap necrosis), with prosthesis removal needed in 2.3% of cases.
- Excellent or good aesthetic outcomes were reported in 92.9% of patients.
- No local recurrences were observed at a median 24-month follow-up.
Conclusions:
- Surgical delay is a valuable technique for expanding nipple-sparing mastectomy indications, particularly in high-risk patients.
- This study represents the largest series of SD with NSM to date, demonstrating favorable safety and aesthetic profiles.
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