Do Nipple Necrosis Rates Differ in Prepectoral Versus Submuscular Implant-Based Reconstruction After Nipple-Sparing Mastectomy?

Abstract

Nipple-sparing mastectomy (NSM) has become increasingly popular, given its oncologic safety and preserved nipple areolar complex (NAC) aesthetics. Reconstruction has recently shifted from traditional submuscular (SM) to prepectoral (PP) implant placement. It remains unclear how the plane of implant placement might affect NAC perfusion. Our goal was to assess postoperative outcomes following NSM with SM versus PP implant placement. A retrospective single-institution review was performed of all patients undergoing NSM and immediate breast reconstruction in either the PP or SM plane from January 2015 to June 2019. Clinicopathologic details and 90-day complication rates were collected. SM and PP group complications were compared using Chi square analysis. A total of 288 breasts (160 patients) were included, including SM in 79 cases (44 patients) and PP in 209 cases (116 patients). Clinicopathologic features between groups were similar. Overall, the rate of NAC necrosis was 15.1%, with no differences between the SM and PP cohorts (p = 0.79). In cases of NAC necrosis, there was no difference between the SM and PP groups in return to the operating room for debridement (p = 1.0) or explant (p = 0.33). In our cohort, immediate implant-based reconstruction in the SM and PP planes following NSM was equally safe with respect to postoperative complications and NAC ischemia.