Nipple-sparing mastectomy Incisions for Cancer Extirpation (NICE) Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes

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. Meeting Presentation: These data were presented in part at Plastic Surgery The Meeting, American Society of Plastic Surgeons, October 2016, Los Angeles, California, USA Financial Disclosure: Dr. Myckatyn is a consultant for Acelity and Allergan. Acelity initially provided Spy kits for perfusion assessment to Dr. Tenenbaum for this study. No other funds or resources were provided for this study. None of the other authors have relevant financial disclosures. Acknowledgements: The authors would like to thank from the Department of Surgery at Washington University School of Medicine in Saint Louis, Ms. Colleen Kilbourne-Glynn for assistance with patient enrollment and data organization. They would like to thank Ms. Annette Irving for assistance with IRB preparation and Ms. Tracey Guthrie for administrative assistance. Corresponding Author: Terence M. Myckatyn, MD, Professor, Plastic and Reconstructive Surgery, West County Plastic Surgeons, Washington University School of Medicine, 1020 N. Mason, Suite 110, Saint Louis, MO 63141, E-mail: myckatyn@wudosis.wustl.edu, Phone: (314) 996-8800, Fax: (314) 367-0225 ©2018American Society of Plastic Surgeons

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