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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2016

01-10-2016 | Breast Oncology

Oncological and Surgical Outcomes After Nipple-Sparing Mastectomy: Do Incisions Matter?

Authors: Cory A. Donovan, MD, Attiya P. Harit, MS, Alice Chung, MD, Jean Bao, MD, Armando E. Giuliano, MD, Farin Amersi, MD

Published in: Annals of Surgical Oncology | Issue 10/2016

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Abstract

Background

While nipple-sparing mastectomy (NSM) for the treatment of breast cancer is becoming more accepted, technical aspects are still evolving. Data regarding risk factors contributing to complications after NSM are limited. This study evaluated technical aspects on outcomes of NSM.

Methods

Review of our database identified 201 patients who had NSM during the period from January 2012 to June 2015. We compared the effect of operative techniques on surgical outcomes.

Results

A total of 351 NSM were performed in 201 patients. Mean patient age was 47 years. Inframammary (47 %) or periareolar (35 %) incisions were most frequent. Tumescence was used in 203 (58 %) NSM. Skin flaps were created using sharp dissection in 213 (61 %) and electrocautery in 138 (39 %) breasts. Nipple areola complex (NAC) necrosis was seen in 56 (16 %) breasts, of which 7 were severe (2 %). A higher rate of NAC complications was seen with periareolar incisions (p = 0.02). Sharp dissection did not result in significant rates of flap necrosis compared with electrocautery. Ten patients (3 %) had a positive anterior/deep margin, of which 7 (64 %) had an inframammary approach. Twenty-two (11 %) patients had an infection that required intravenous antibiotics. Fourteen (7 %) patients had implant loss. Dissection technique was not associated with implant loss (p = 1.0) or infection (p = 0.84). Forty-two (12 %) patients had radiation and seven (16 %) required implant removal.

Conclusions

NSM has an acceptable complication rate. NAC necrosis requiring excision or implant loss is rare. Postmastectomy radiation is a significant risk factor for implant loss. Inframammary incisions have fewer ischemic complications but may result in tumor-involved margins.
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Metadata
Title
Oncological and Surgical Outcomes After Nipple-Sparing Mastectomy: Do Incisions Matter?
Authors
Cory A. Donovan, MD
Attiya P. Harit, MS
Alice Chung, MD
Jean Bao, MD
Armando E. Giuliano, MD
Farin Amersi, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5323-z

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