Nipple necrosis rate with submuscular versus prepectoral implant-based reconstruction in nipple sparing mastectomy: Does it differ?

• Published in: The American journal of surgery Vol. 230; pp. 57 - 62
• Main Authors: ElSherif, Ayat, Bernard, Steven, Djohan, Risal, Atallah, Amani, Tu, Chao, Valente, Stephanie A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024; Elsevier Limited
• Subjects: Acellular dermal matrix; Body mass index; Cancer therapies; Chemotherapy; Demographics; Implant reconstruction; Lymphatic system; Mastectomy; Necrosis; Nipple necrosis; Nipple-sparing mastectomy; Nipples; Patients; Prepectoral; Prostheses; Radiation; Review boards; Skin; Submuscular; Surgeons; Surgery; Transplants & implants; Nipple necrosis; Submuscular; Acellular dermal matrix; Nipple-sparing mastectomy; Implant reconstruction; Prepectoral
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2023.11.039

This study aims to compare the rate of nipple necrosis between the submuscular (SM) versus the prepectoral (PP) implant placement after immediate breast reconstruction (IBR). An institutional review board-approved database was reviewed of patients who underwent nipple sparing mastectomy (NSM) with IBR at our institution between 2016 and 2019. Patients who had SM versus PP IBR were compared. Incidence of nipple necrosis was evaluated between the two groups. A total of 525 NSM with IBR were performed in 320 patients with SM reconstruction in 61% (n ​= ​322) and PP in 39% (n ​= ​203) of the mastectomies. Overall, 43 nipples experienced some form of necrosis with 1% of mastectomies experiencing nipple loss. There was no difference between SM group and PP group at the rate of nipple necrosis (9 ​% vs 7 %, P ​= ​0.71). In patients undergoing NSM with IBR, the rate of nipple necrosis, nipple loss or complications did not differ between groups whether the implant was placed SM or PP, supporting the safety of this newer procedure. •Prepectoral implant reconstruction is regaining popularity as a reconstruction technique•Prepectoral reconstruction can be performed in patients undergoing nipple-sparing mastectomy with no compromise of nipple vascularity•Plastic surgeon training and level of performance will impact the precpectoral reconstruction outcome as surgeons go through the learning curve.