Initial Outcomes of a Novel Technique of Nipple Sparing Mastectomy Without Reconstruction

Introduction: Nipple sparing mastectomy is oncologically safe and has a good cosmetic outcome. However, nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to conserve their nipple areolar complex (NAC) and avoid the transverse scar associated with modified radical mastectomy. This is the first study on the outcomes of MSM. Methods: MSM complications and their risk factors, recurrence rates and cosmetic outcomes were assessed. As MSM is a modification of the round block technique, the mean ring distance (MRD), which is the average of the distance between the inner and outer ring circumferentially, was assessed, too. Results: A total of 28 patients (29 breasts) were analysed. There was no recurrence after a mean/median follow-up of 40.3/41 months (4-80 months). In the initial recruitment of 17 patients (18 breasts), NAC necrosis occurred in eight cases (three complete, five partial). Prediabetes (p = 0.0128) and MRD ≥1.5 cm (p = 0.0440) were statistically significant for NAC necrosis. Of the available data, 11/15 (73.3%) rated the cosmetic outcome as excellent/good, with poorer cosmetic outcome correlated with NAC necrosis (p = 0.006). Avoiding the above risk factors in the next 11 patients, NAC necrosis decreased to 1/11 (9.0%) with mild ischaemia. Cosmetic outcome was rated as excellent/good in 90.9%. Conclusions: MSM is oncologically safe and is best performed in patients with no risk factors for NAC necrosis, including prediabetes and MRD < 1.5 cm. These pilot results will refine the selection criteria of patients for MSM.