Nipple-Sparing Mastectomy and Infection Risk after Immediate Breast Reconstruction.

BACKGROUND

Wound complications are known to occur after nipple-sparing mastectomy (NSM), especially in procedures involving a periareolar incision. We sought to determine the independent risk of infection and overall wound complications associated with NSM vs skin-sparing mastectomy (SSM) in a contemporary cohort of women undergoing immediate implant reconstruction.

STUDY

DESIGN

We identified 352 women 21 years of age or older undergoing mastectomy and immediate implant reconstruction from September 2021 to December 2022 using electronic health records from 2 hospitals. The relative risk (RR) of surgical site infection (SSI) and of serious wound complication (infection or noninfectious wound complication [NIWC; dehiscence or tissue necrosis] requiring surgical treatment in the operating room) within 180 days after surgery associated with NSM vs SSM was determined using a modified Poisson regression model, controlling for established risk factors for SSI.

RESULTS

NSM was performed in 128 women (36.4%), most commonly via an inframammary fold incision (73.4%). SSI occurred in 49 (13.9%) women within 180 days after surgery, whereas 70 (19.9%) women developed an SSI or NIWC. Although the incidence of SSI and the composite SSI/NIWC outcomes was similar after NSM vs SSM (14.8% vs 13.4% and 21.1% vs 19.2%, respectively); in multivariable analysis, NSM was associated with increased risk of both SSI (RR 2.13, 95% CI 1.26 to 3.59) and SSI/NIWC (RR 2.19, 95% CI 1.40 to 3.43).

CONCLUSIONS

NSM was associated with increased risk of both SSI and NIWCs requiring surgical treatment after controlling for other established risk factors, despite uncommon use in this cohort of a periaerolar incision. This information should be communicated to women at the time of presurgical counseling to facilitate shared decision-making.