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Nipple-areola preserving mastectomy has significantly low rates of necrosis

Nipple-areola preserving mastectomy had fewer postoperative complications and provided improved blood supply due to vascular delay compared with nipple-sparing mastectomy, according to study results published in Plastic and Reconstructive Surgery Global Open.

The major component of the nipple-areola preserving procedure is a 20 cm × 15 cm piece of 0.05 cm thick reinforced silicone sheet (Alliedsil, Allied Biomedical, California) that is cut to fit the dissected area and placed between the skin and the breast tissue along with a 15-French Blake drain at the bottom of the pocket.

The study included 70 patients undergoing breast reconstruction between October 2010 and June 2015. A study group of 24 patients (45 flaps) underwent the two-stage nipple-areola preserving procedure and a control group of 46 patients (75 flaps) underwent standard nipple-sparing procedures. The study group underwent the first stage of the procedure 2 to 3 weeks before scheduled mastectomies.

There were no intraoperative complications for either group. Postoperative complications in the study group included skip flap necrosis (n = 2) and infection (n = 1). Postoperative complications in the control group included skin flap necrosis (n = 26), nipple necrosis (n = 9), infection (n =2), venous congestion (n = 1) or other condition (n = 4).

The control group had a significantly greater length of hospitalization postoperatively (P = .0064). However, the control group also had greater rates of preoperative and postoperative adjuvant chemotherapy compared with the study group (P = .0042) as well as greater rates of malignant conditions compared with the predominantly benign conditions in the study group. (P = .0039).

“By interposing it between the [nipple-areola complex]-central breast skin and the underlying vascular parenchyma, the silicone sheet serves as a barricade to prevent revascularization from beneath and results in augmentation of the overlying tissue’s blood flow through the subdermal plexus vasculature peripherally,” the researchers wrote. “An additional benefit of predissection and placement of the silicone sheet is the facilitation of the subsequent mastectomy by serving both to expedite the procedure and limit further dissection of the delicate skin flaps and [nipple-areola complex].” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.