Abstract P3-13-15: An update on trends in nipple-sparing mastectomy incision locations: A systematic review of the literature with pooled analysis
Authors: Santos PJF , Daar DA , Mowlds DS , Wirth GA , Lane KT 
Published: March 2017

Abstract
Introduction: The incidence of nipple-sparing mastectomy (NSM) has greatly increased, owing to refinements in technique, increased surgeon comfort and the superior aesthetic outcome afforded by retention of the nipple-areola complex (NAC).1 The indications for nipple-sparing mastectomy continue to broaden as the oncologic safety of nipple preservation is elucidated.2 Incision location varies widely among surgeons and likely contributes to the complication profile associated with these procedures. While small studies have looked at complications associated with NSM,3 the preferred incision location has not been determined.
Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. Search terms “nipple-sparing,” “nipple-areola sparing,” or “total skin-sparing” were used in PubMed and MEDLINE databases from January 2013 to October 2015. Studies were included if the mastectomy incision type was described and accompanied by the overall and/or respective complication profile. A pooled analysis was completed for the overall NAC necrosis rate as well as for necrosis by incision type.
Results: Of the 162 studies identified, 32 studies met the inclusion criteria, and a total of 4,986 nipple-sparing mastectomies were available for analysis. Incision types were divided into 6 categories: inframammary (2,030 NSMs, 40.7%), radial (1,247 NSMs, 25%), periareolar (922 NSMs, 18.5%), endoscopic (444 NSMs, 8.9%), mastopexy/previous scar (271 NSMs, 5.4%), and other (72 NSMs, 1.4%). Thirty different incision variations were used, in total. Among the 26 studies reporting overall NAC necrosis rates (3,831 NSMs), the pooled NAC necrosis rate was 9.3%. Seventeen studies reported their rates of necrosis by incision location (1,736 mastectomies): inframammary, 11.6%; radial, 13.8%; periareolar, 18.2%; endoscopic, 17.4%; mastopexy/previous scar, 5.7%; and other, 0.0%.
Conclusion: The inframammary incision has become the preferred NSM incision as it minimizes disruption of the blood supply to the NAC as evidenced by its superior complication profile. Many studies fail to report their complications as they relate to incision location. Consistent reporting in the literature is warranted as a means of further elucidating the short and long-term complication profiles associated with NSM incision location.
1. Agarwal S, Agarwal S, Neumayer L, Agarwal JP. Therapeutic nipple-sparing mastectomy: trends based on a national cancer database. Am J Surg. 2014;208(1):93-8.
2. Krajewski AC, Boughey JC, Degnim AC, et al. Expanded Indications and Improved Outcomes for Nipple-Sparing Mastectomy Over Time. Ann Surg Oncol. 2015;22(10):3317-23.
3. Colwell AS, Tessler O, Lin AM, et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg. 2014;133(3):496-506.
Citation Format: Santos PJF, Daar DA, Mowlds DS, Wirth GA, Lane KT. An update on trends in nipple-sparing mastectomy incision locations: A systematic review of the literature with pooled analysis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-15.