Journal Article

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy

Mirocha, James, Chung, Alice P., Wang, Xuanji, Amersi, Farin F., Weed, Christina, Jackson, Jordan, Giuliano, Armando E., Boyle, Marissa K.

2025

Overview

Background Nipple delay (ND) is a staged procedure that improves nipple-areolar complex (NAC) viability in nipple-sparing mastectomy (NSM) patients who are high-risk for NAC or skin-flap necrosis. This study compared postoperative outcomes and risk factors between patients treated with ND-NSM and NSM alone. Methods Patient demographics, risk factors for NAC or skin-flap necrosis, tumor characteristics, and operative outcomes were compared between ND-NSM and NSM groups from 2009 to 2023. Univariate and multivariate analyses were performed to identify significant variables associated with NAC or skin-flap necrosis. Results Overall, 71 ND-NSM patients and 537 NSM patients were compared. ND-NSM patients had larger breasts ( p  < 0.01), body mass index ≥ 30 ( p  = 0.01), prior breast/chest wall radiation (XRT) [ p  < 0.01], prior breast operations ( p  < 0.01), less axillary surgery ( p  < 0.01), more autologous tissue reconstruction over implant-based reconstruction compared with NSM patients ( p  = 0.02), and more prophylaxis ( p  < 0.01). There were no statistically significant differences between groups in regard to infection, skin-flap necrosis, NAC necrosis, seromas, and hematomas. No patients in the ND-NSM group had NAC necrosis and 1 patient had skin-flap necrosis, compared with 17 and 13 patients in the NSM group, respectively ( p  = 0.24). On univariate analysis, prior XRT was associated with increased risk for skin-flap necrosis ( p  = 0.02). Multivariate analysis showed XRT was associated with skin-flap necrosis ( p  = 0.02) and any necrosis ( p  = 0.01). Breast size was associated with NAC or skin-flap necrosis ( p  = 0.04). Conclusion Larger breasts and XRT were risk factors for NAC or skin-flap necrosis; however, despite having more risk factors, ND-NSM patients had very low rates of necrosis. Notably, no nipples were lost. A shared decision should be made with patients regarding the risks and benefits of ND-NSM.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Body mass index / Breast / Breast Neoplasms - pathology / Breast Neoplasms - surgery / Breast Oncology / Breasts / Disease prevention / Female / Follow-Up Studies / Hematoma / Humans / Mammaplasty - methods / Mastectomy / Mastectomy - adverse effects / Mastectomy - methods / Mastectomy, Subcutaneous - methods / Medicine / Medicine & Public Health / Middle Aged / Multivariate analysis / Necrosis / Necrosis - etiology / Nipples / Nipples - pathology / Nipples - surgery / Oncology / Organ Sparing Treatments - methods / Patients / Postoperative Complications / Prognosis / Reconstructive surgery / Retrospective Studies / Risk Factors / Skin / Statistical analysis / Surgery / Surgical Flaps / Surgical Oncology