Abstract
Nipple-sparing mastectomy (NSM) improves cosmetic outcome of mastectomy, but many patients are not candidates for this procedure because of concerns about nipple-areolar viability. Surgical delay is a technique that has been used for more than 400 years to improve survival of skin flaps. We used a surgical delay procedure to improve nipple viability in patients who were identified to be at high risk for nipple necrosis following NSM. Patients at high risk for nipple necrosis following NSM underwent a surgical delay procedure 7-21 days prior to mastectomy. Subareolar biopsy and sentinel node biopsy, if indicated, were performed at the time of the delay procedure. Nipple viability was assessed before and after NSM. If the subareolar biopsy revealed malignancy, the NAC was removed at the time of mastectomy. 31 NAC in 20 patients underwent surgical delay. All of the NAC subjected to a surgical delay survived following the delay procedure. In 2 patients, the subareolar biopsy was positive and 3 NAC were removed at the time of mastectomy (1 for purposes of symmetry). Of the 28 delayed NAC left at the time of NSM, all survived the post-mastectomy course. A procedure to surgically delay the NAC 7-21 days prior to NSM is demonstrated to ensure viability of NAC in patients previously thought to be at high risk for nipple loss.
Highlights
No patient developed wound infection within the first 4 weeks after surgery. In his initial report on nipple-sparing mastectomy, Bromley Freeman described removal of the breast gland through an inframammary incision and immediate or delayed insertion of a breast implant.[18]
The decision to delay placement of the breast implant allowed the retained skin and nipple–areolar complex to adapt to the ischemic insult which is inevitably produced by mastectomy; this adaptation likely involves the enlargement of blood vessels and/or the growth of new blood vessels parallel to the surface of the skin.[16]
Palmieri and coworkers reported a technique based on the use of laparoscopic instruments to undermine the nipple–areolar complex and surrounding skin 3 weeks prior to mastectomy.[19]
Summary
To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis, we have used a delay procedure for the nipple–areolar complex to be done prior to nipple-sparing mastectomy. Patients were considered to be at higher risk for nipple necrosis following nipple-sparing mastectomy if they met one or more objective risk factors: breast ptosis (defined by location of the nipple–areolar complex below the inframammary crease and suprasternal notch to nipple distance of 26 cm or more), pre-existing breast scars, and history of active cigarette smoking.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
