A New Convenient Incision Model of the Nipple-Sparing Mastectomy: Lateralized Parabolic Multiplanar Incision

Area of Science:

• Plastic Surgery
• Oncology
• Breast Reconstruction

Background:

• Nipple-sparing mastectomy (NSM) aims to preserve the nipple-areola complex (NAC) during breast cancer surgery.
• Traditional incisions can lead to NAC necrosis and lateral displacement, compromising aesthetic results.
• Maintaining the natural appearance and function of the NAC is crucial for patient satisfaction.

Purpose of the Study:

• To introduce and evaluate a novel lateralized parabolic multiplanar incision for NSM.
• To reduce the incidence of NAC necrosis and lateral displacement.
• To ensure the scar is imperceptible from an anterior view and maintain the NAC's round shape.

Main Methods:

• A cohort of 243 patients undergoing NSM and immediate implant-based breast reconstruction were included.
• A lateralized parabolic incision was designed, positioned 4-5 cm from the lateral border of the NAC, extending beyond the anterior axillary line.
• Surgical technique focused on preserving vascularity to the NAC and creating a scar that avoids anterior visibility.

Main Results:

• The mean follow-up was 24.6 months, with a mean patient age of 42.3 years.
• Full-thickness NAC necrosis occurred in 3.6% of breasts; lateral displacement was not observed in any patient.
• The average scar length was 8.6 cm, with preserved round NAC appearance in most cases, and no anteriorly visible scars.

Conclusions:

• The lateralized parabolic multiplanar incision is an effective technique for NSM, facilitating access to all breast quadrants.
• This method successfully maintains NAC viability, prevents lateral displacement, and ensures aesthetic preservation of the NAC's form.
• The technique provides excellent cosmetic results with non-visible anterior scarring and is suitable for immediate breast reconstruction.