Inframammary versus Periareolar Incision: A Comparison of Early Complications in Nipple-sparing Mastectomy

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Abstract
Background: Nipple-sparing mastectomy (NSM), either used therapeutically or prophylactically, may yield more complications than conventional mastectomy. The incision may affect aesthetic outcome and complication rates, with periareolar incisions being associated with nipple–areolar complex (NAC) necrosis. Methods: Early complications were compared between NSM performed in 2015–2022 using inframammary fold (IMF) or periareolar incisions. Results: Overall, 180 procedures in 152 patients (bilateral NSM = 28) were included (IMF = 104; periareolar = 76). Mean age (47 versus 43.9 years; P < 0.038), mastectomy weight (312.7 versus 246.8 grams; P < 0.001), implant volume (447.5 versus 409.0 mL; P = 0.002), and use of tissue expanders (68.4% versus 50.0%; P = 0.013) were all greater with periareolar incisions. Prepectoral reconstruction was more common with IMF (18.3% versus 3.9%; P = 0.004). Forty-three complications (23.9%) were recorded (periareolar n = 27, 35%; IMF n = 16, 15.3%; P = 0.0002). NAC necrosis accounted for 17 complications (22.4%) in the periareolar group versus nine (8.5%) in the IMF group (P = 0.002). Necrosis was predominantly moderate (n = 6, 8.3% versus n = 1, 1.0%, respectively) (P = 0.014). Unadjusted odds ratios (OR) for complications [3.05; 95% confidence interval (CI): 1.27–7.26] and necrosis (3.04; 95% CI: 1.27–7.27) were higher in the periareolar group. In the multivariate analysis, necrosis was associated with periareolar incisions [adjusted odds ratio (aOR): 2.92; 95% CI: 1.14–7.44]. Prepectoral reconstruction was associated with IMF incisions (aOR: 25.51; 95% CI: 3.53–184.23; P = 0.001) and with body mass index of more than 25–30 (aOR: 37.09; 95% CI: 5.95–231.10; P < 0.001). Therapeutic mastectomies (aOR: 68.56; 95% CI: 2.50–188.36; P = 0.012) and tissue expanders (aOR: 18.36; 95% CI: 1.89–178.44; P = 0.026) were associated with seromas. Conclusions: Both incisions are viable options; however, the risk of NAC necrosis increased with the periareolar approach. Further research is required.

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