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Continuous Topical Oxygen Therapy Is Associated with Accelerated Nipple-Areolar Complex Necrosis Healing Following
Hyung-Suk Yi1, Ho-Young Im1, Jin-Hyung Park1
1Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Republic of Korea.
Background/Objectives:
Nipple-areolar complex (NAC) necrosis following nipple-sparing mastectomy (NSM) delays adjuvant therapy and compromises oncological outcomes. This retrospective propensity-matched cohort study compared continuous topical oxygen therapy (cTOT), hyperbaric oxygen therapy (HBOT), and standard care (SOC) in patients with NAC necrosis after NSM.
Methods:
Between January 2020 and August 2025, 213 patients with NAC necrosis after NSM at a single academic center met eligibility criteria (cTOT, n = 57; HBOT, n = 59; SOC, n = 97). Propensity score matching (1:1:1, 15 covariates, all standardized mean differences < 0.1) yielded 57 matched triplets (171 patients). The primary outcome was time to complete epithelialization, with restricted mean survival time (RMST) at 56 days designated as a co-primary metric.
Results:
cTOT was associated with the fastest healing (mean 30.5 ± 9.9 days vs. HBOT 36.4 ± 9.0, p = 0.007, vs. SOC 45.1 ± 10.6, p < 0.001). RMST analysis demonstrated a mean gain of 14.0 unhealed days (95% CI, 10.5-17.5) for cTOT versus SOC. Eight-week healing rates were 98.2% (cTOT), 96.5% (HBOT), and 87.7% (SOC). Multivariable Cox regression identified cTOT as an independent predictor of accelerated healing (HR 4.61; 95% CI, 2.99-7.11; p < 0.001), with results stable across incision-type and ptosis-grade sensitivity analyses. The treatment association was most pronounced in larger wounds (≥2.0 cm2; HR 6.85; p for interaction = 0.018). cTOT patients also reported significantly lower pain and higher satisfaction, with no device-related discontinuations (0/57).
Conclusions:
cTOT was associated with significantly accelerated NAC necrosis healing and, as a portable home-based therapy, may support oncological treatment timelines after NSM. The shorter time to adjuvant initiation observed for cTOT (continuous outcome) was not paralleled by a significant reduction in the >6-week delay endpoint, which requires confirmation in multicenter randomized trials.
