Is There A Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis

Background: The incidence of nipple-sparing mastectomy (NSM) is rising, but no single incision type has been proven to be superior. This study systematically evaluates the rate and efficacy of various NSM incision locations, focusing on nipple areola complex (NAC) necrosis and reconstructive method. Methods: A systematic literature review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines identifying studies on NSM where incision type was described. Pooled descriptive statistics with meta-analysis of overall (NAC) necrosis rate and NAC necrosis by incision type was performed. Results: Fifty-one studies (9,975 NSMs) were included. Thirty-two incision variations were identified and categorized into one of 6 groups: inframammary fold (IMF), radial, periareolar, mastopexy/prior scar/reduction, endoscopic, and other. The most common incision types were IMF (3,634 NSM, 37.8%) and radial (3,575 NSM, 37.2%). Meta-analysis revealed an overall partial NAC necrosis rate of 4.62% (95% CI, 3.14-6.37%) and total NAC necrosis rate of 2.49% (95% CI, 1.87-3.21%). Information on overall NAC necrosis rate by incision type was available for 30/51 studies (4,645 NSMs). Periareolar incision had the highest NAC necrosis rate (18.10%). Endoscopic and mastopexy/prior scar/reduction incisions had the lowest rates of NAC necrosis at 4.90% and 5.79%, respectively, followed by the IMF incision (6.82%). The rate of single-stage implant reconstruction increased during this time period. Conclusion: For NSM, the periareolar incision maintains the highest NAC necrosis rate due to disruption of the NAC blood supply. The IMF incision has become the most popular incision, demonstrating an acceptable complication profile. ŧ Co-senior authors Disclosure: The authors have no financial interest to declare in relation to the content of this work. Corresponding author: David A. Daar, MD, MBA, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 305 East 33rd St. Lower Level, New York, NY 10016, Daard01@nyumc.org, 847.276.1310 ©2019American Society of Plastic Surgeons

from A via a.sfakia on Inoreader https://ift.tt/2V7WKDz