Impact of incision type in breast cancer-conserving mastectomy: a comparative analysis of outcome

Conserving mastectomy is widely used due to its cosmetic benefits and the possibility of undergoing immediate breast reconstruction. The types of incisions vary, and the best method remains a topic of debate. In this study, we evaluate the impact of the incision type on complication outcomes. A retrospective analysis was conducted, considering all conserving mastectomies and dividing them into groups based on the incision type. A total of 290 patients were enrolled: 34 (11.7%) had a radial incision, 95 (32.8%) transverse incision with skin or NAC excision, 48 (16.6%) inframammary fold incision, 39 (13,4%) omega incision, 37 (12.8%) periareolar incision, and 37 (12.8%) Wise-pattern incision. Flap ischemia, NAC necrosis, and skin necrosis had a higher incidence rate in patients who underwent the Wise-pattern incision and periareolar incision, with relative p values of <0.001, 0.041, and 0.035, respectively. Considering only nipple-sparing mastectomies in breast cancer patients, overall complications, skin necrosis, and delay in adjuvant treatments showed a higher incidence in patients who underwent Wise-pattern incisions. The relative p values were 0.001, 0.004, 0.054, and 0.001, respectively. In multivariate analysis, inframammary fold incision reduced the risk of nipple necrosis, while Wise-pattern incision increased the risk (OR 0.656; 3.611-fold and p value were, respectively, 0.026 and 0.038). Wise-pattern incision and periareolar incision increase the incidence of complications as nipple areola complex (NAC) and skin necrosis but do not affect reconstruction failure. Inframammary fold incision reduces the risk of complications. The incision should be customized based on the tumor location, biology and extent, breast volume, ptosis, type of reconstruction, and risk factors.