E29: Impact of Incision Design During Skin- and Nipple-Sparing Mastectomy with Breast Reconstruction on Postoperative Outcomes

ePoster Abstract Author(s)

Diego A. Gomez, BS (he/him/his)

Medical Student
Mayo Clinic Alix School of Medicine
Scottsdale, Arizona, United States

Submitter(s)

Diego A. Gomez, BS (he/him/his)

Medical Student
Mayo Clinic Alix School of Medicine
Scottsdale, Arizona, United States

Author(s)

Diego A. Gomez, BS (he/him/his)

Medical Student
Mayo Clinic Alix School of Medicine
Scottsdale, Arizona, United States
NI

Nadia Islam, BS

Medical Student
Mayo Clinic Alix School of Medicine, United States
Chi Zhang, MD

Surgical Resident
Department of Surgery, Mayo Clinic Arizona
Scottsdale, Arizona, United States
HK

Heidi Kosiorek, MS

Biostatistician
Department of Research and Biostatistics, Mayo Clinic Arizona, United States
Jacob B. Hammond, MD

Surgical Resident
Department of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Anschutz, Colorado
Phoenix, AZ, United States
Patricia A. Cronin, MD

Assistant Professor of Surgery
Department of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona
Pheonix, Arizona, United States
JB

Julie A. Billar, MD

Senior Associate Consultant
Department of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, United States
ER

Edward M. Reece, MD, MS

Professor
Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, United States
AR

Alanna M. Rebecca, MD

Associate Professor
Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, United States
WC

William J. Casey, III, MD

Associate Professor
Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, United States
DR

Daniel H. Rhee, MD

Senior Associate Consultant
Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, United States
Barbara A. Pockaj, MD

Professor
Department of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona
Scottsdale, AZ, United States

Introduction: Incision design during skin- and nipple-sparing mastectomy with reconstruction is dependent on a variety of oncologic, aesthetic, and reconstructive factors. Controversy exists around the optimal mastectomy incision location. We examine the impact of mastectomy incision design during post-mastectomy breast reconstruction on surgical outcomes.

Methods: Patients who underwent post-mastectomy breast reconstruction between 2008-2020 at our institution were classified based on mastectomy incision design. Rates of complications were collected for each patient and were compared within skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) groups.

Results: A total of 630 patients met inclusion criteria. Skin-sparing incisions included horizontal ellipse (n=185), vertical ellipse (n=33), and Wise pattern (n=53). Nipple-sparing incisions included lateral breast-splitting (n=153), breast-splitting other (medial or vertical radial incision, n = 23), inframammary (n=120), and lateral inframammary (n=60). No differences in the rate of overall or major complications (those requiring return to the operating room) were found within SSM or NSM groups. Rates of capsular contracture, infection, hematoma, seroma formation, and implant explantation were similar. There were no differences in wound breakdown or mastectomy ischemia among the SSM group. However, NSM patients undergoing a breast-splitting medial or vertical incision had greater rates of wound breakdown (p< 0.001), but only 57% required surgical intervention whereas most of the other incision types required surgical intervention if wound breakdown developed. Other breast-splitting and inframammary incisions had the highest incidence of mastectomy flap ischemia (p=0.022). Breast-splitting other and lateral had the highest rate of nipple complications although inframammary had the highest rate of complete nipple loss (p< 0.001). No differences were identified in the rate of unplanned revisions, performed for both cosmetic and complication-related reasons (infection, flap exploration, or wound debridement).

Conclusions: Our study found no differences in postoperative complications for different SSM incisions and minimal differences for NSM incisions. This data supports the use of various types of incisions based upon each patient’s oncologic and cosmetic need.

Learning Objectives:

Upon completion, participant will be able to list various incision designs used in skin-sparing mastectomy
Upon completion, participant will be able to list various incision designs used in nipple-sparing mastectomy
Upon completion, participant will be able to recognize complications arising from post-mastectomy breast reconstruction based on incision design