Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy

Area of Science:

• Oncology
• Plastic Surgery
• Breast Surgery

Background:

• Nipple-sparing mastectomy (NSM) is a breast cancer surgery option.
• Nipple-areolar complex (NAC) necrosis is a risk following NSM, especially in high-risk patients.
• Nipple delay (ND) is a staged procedure to improve NAC viability in high-risk NSM patients.

Purpose of the Study:

• To compare postoperative outcomes and identify risk factors between patients treated with ND-NSM and NSM alone.
• To evaluate the effectiveness of ND in mitigating NAC or skin-flap necrosis.

Main Methods:

• Retrospective comparison of 71 ND-NSM patients and 537 NSM patients (2009-2023).
• Analysis of patient demographics, risk factors (e.g., prior radiation, breast size), tumor characteristics, and operative outcomes.
• Univariate and multivariate analyses to identify significant risk factors for NAC or skin-flap necrosis.

Main Results:

• ND-NSM patients had higher rates of larger breasts, BMI ≥ 30, prior radiation, and prior breast operations.
• No statistically significant differences in infection, skin-flap necrosis, NAC necrosis, seromas, or hematomas between groups.
• Zero NAC necrosis and one skin-flap necrosis in the ND-NSM group versus 17 NAC and 13 skin-flap necrosis in the NSM group.
• Prior radiation (XRT) and larger breast size were significant risk factors for necrosis.

Conclusions:

• Despite increased risk factors, ND-NSM demonstrated very low rates of necrosis, with no nipple loss.
• Larger breasts and prior radiation increase the risk of NAC or skin-flap necrosis.
• Shared decision-making is crucial for discussing ND-NSM risks and benefits with patients.