Continuous Topical Oxygen Therapy Is Associated with Accelerated Nipple-Areolar Complex Necrosis Healing Following Nipple-Sparing Mastectomy: A Propensity-Matched Three-Way Comparison.

BACKGROUND/

OBJECTIVES

Nipple-areolar complex (NAC) necrosis following nipple-sparing mastectomy (NSM) delays adjuvant therapy and compromises oncological outcomes. This retrospective propensity-matched cohort study compared continuous topical oxygen therapy (cTOT), hyperbaric oxygen therapy (HBOT), and standard care (SOC) in patients with NAC necrosis after NSM.

METHODS

Between January 2020 and August 2025, 213 patients with NAC necrosis after NSM at a single academic center met eligibility criteria (cTOT, n = 57; HBOT, n = 59; SOC, n = 97). Propensity score matching (1:1:1, 15 covariates, all standardized mean differences < 0.1) yielded 57 matched triplets (171 patients). The primary outcome was time to complete epithelialization, with restricted mean survival time (RMST) at 56 days designated as a co-primary metric.

RESULTS

cTOT was associated with the fastest healing (mean 30.5 ± 9.9 days vs. HBOT 36.4 ± 9.0, p = 0.007, vs. SOC 45.1 ± 10.6, p < 0.001). RMST analysis demonstrated a mean gain of 14.0 unhealed days (95% CI, 10.5-17.5) for cTOT versus SOC. Eight-week healing rates were 98.2% (cTOT), 96.5% (HBOT), and 87.7% (SOC). Multivariable Cox regression identified cTOT as an independent predictor of accelerated healing (HR 4.61; 95% CI, 2.99-7.11; p < 0.001), with results stable across incision-type and ptosis-grade sensitivity analyses. The treatment association was most pronounced in larger wounds (≥2.0 cm2; HR 6.85; p for interaction = 0.018). cTOT patients also reported significantly lower pain and higher satisfaction, with no device-related discontinuations (0/57).

CONCLUSIONS

cTOT was associated with significantly accelerated NAC necrosis healing and, as a portable home-based therapy, may support oncological treatment timelines after NSM. The shorter time to adjuvant initiation observed for cTOT (continuous outcome) was not paralleled by a significant reduction in the >6-week delay endpoint, which requires confirmation in multicenter randomized trials.