Abstract P2-15-08: Aesthetic Incisions and Early Complications for Nipple-sparing Mastectomy followed by Immediate Breast Reconstruction
Authors: Cavalcante Francisco Pimentel , Novita Guilherme , Lima Ticiane Oliveira , Alcantara Ryane , Cardoso Amanda , Ulisses Flora , Zerwes Felipe , Millen Eduardo 
Published: March 2023

Abstract
Introduction: Nipple-sparing mastectomy (NSM) is a surgical alternative for patients who are not candidates for breast-conserving therapy in early breast cancer or even for women who are candidates for risk-reducing mastectomies, facilitating immediate breast reconstruction. Aesthetic incisions such as through the inframammary fold (IMF) or periareolar (PA) are viable options for radial scars, with better cosmetic results and less visibility. Little is known about early surgical complications between these two techniques. Objectives and methods The aim of this study was to evaluate early complications (NAC necrosis [mild, partial or total], infection, seroma, hematoma, dehiscence and reconstruction failure) in patients undergoing NSM via esthetic incisions (IMF or PA) and immediate breast reconstruction in a unique Brazilian institution. A retrospective analysis was performed at Hospital Geral de Fortaleza (HGF) between 2015 and 2022, including patients with a minimum follow-up of 3 months and complete data in the medical records. The following demographic parameters were evaluated: age, body mass index, co-morbidities, use of direct implant or tissue expander, breast weight and pre-pectoral or submuscular reconstruction. Pearsons chi squared tests and t-test were performed and a p value of &lt; 0.05 was considered statistically significant. Results A total of 180 NSM through IMF (n=106) or PA (n=74) incisions were included and 43 cases (23.9%) of complications were observed: 27 in the PA group (62.8%) and 16 in the IMF (37.2%), with this difference being significant (p=0.0002). Regarding NAC necrosis, 65.4% were observed in the PA incision (n=17; 22.4%), compared to 34.6% in the IMF (n=9; 8.7%) (p=0.0023). There was no significant difference in relation to other complications (n=7 [IMF] vs n=10 [PA]), just as there was no difference in relation to the demographic parameters evaluated, except for the pre-pectoral and direct-to-implant reconstruction, which were more frequently performed in the IMF group: 19 (18.3%) vs 3 (4%) and 52 (50%) vs 24 (31.6%) cases respectively. Only 2 patients had breast reconstruction failure, both in the PA cohort. Conclusions Both incisions are viable options for accessing the NSM, with an acceptable rate of complications. The PA incision is related to a higher complication rate compared to IMF, based mainly on the NAC necrosis rate. More studies are needed for a better understanding of this scenario.
Citation Format: Francisco Pimentel Cavalcante, Guilherme Novita, Ticiane Oliveira Lima, Ryane Alcantara, Amanda Cardoso, Flora Ulisses, Felipe Zerwes, Eduardo Millen. Aesthetic Incisions and Early Complications for Nipple-sparing Mastectomy followed by Immediate Breast Reconstruction [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-08.