부산대학교 도서관

BACKGROUND:: Nipple-sparing mastectomy (NSM) offers several advantages for women seeking post-mastectomy breast reconstruction, but compromised skin and nipple perfusion may lead to skin and nipple necrosis. It is unclear if the incisional approach contributes to these complications; therefore, the purpose of this study was to compare the impact of incision type on outcomes in patients undergoing NSM. METHODS:: This is a prospective cohort study of patients undergoing NSM with prosthetic breast reconstruction through an inframammary fold (IMF) versus a lateral radial (LR) incision. Skin and nipple perfusion as represented by fluorescent intensity, mammometric parameters, patient-reported outcomes, and clinical outcomes were analyzed and compared for the two cohorts and multivariable logistic regression models were performed to evaluate effects of covariates on outcomes. RESULTS:: 79 patients were studied: 55 in the IMF cohort and 24 in the LR cohort. The IMF group had significantly less fluorescent intensity to the inferior (21.9% vs 36.9%, p=0.001) and lateral portions of breast skin (23.1% vs 40.7%, p=0.003) after reconstruction. Decreased fluorescent intensity was associated with smoking, decreased mean arterial pressure, and greater specimen weight. Post-reconstruction breast volumes were increased over preoperative volumes in the IMF group (38.3%) versus the LR (31.2%) group; however patients with a LR incision had a greater increase in satisfaction with their breasts and psychosocial well-being. CONCLUSIONS:: There are significant differences in patient-reported outcomes and final breast volumes based on the incisional approach to NSM. These data can be used to guide providers and counsel patients considering NSM with prosthetic reconstruction.