Eccentric hemiareolar incision with lateral extension for nipple-sparing mastectomy and autologous breast reconstruction.

Nipple-sparing mastectomy (NSM) continues to increase in popularity with its oncological safety demonstrated in a cohort of patients with primary malignancy and in those undergoing risk-reducing surgery. Currently, there is a paucity in literature regarding clinical outcomes of nipple areolar complex (NAC) complications in patients undergoing autologous reconstruction following NSM via hemiareolar incisions with lateral extensions. We present eccentric hemiareolar incision with lateral extension, as an evolution of the previous Omega technique that avoids medial extension. A 1-year retrospective analysis was conducted of 62 consecutive patients who underwent mastectomy and autologous reconstruction between January 2024 to December 2024. Among them, 21 patients underwent NSM (16 eccentric hemiareolar excision with lateral extension and 5 inframammary fold [IMF] incision) and 41 patients underwent traditional skin-sparing (nipple-sacrificing) mastectomy. Nipple necrosis rate in the eccentric hemiareolar with lateral extension group was 12.5% compared to 20% in the IMF NSM group. The overall nipple necrosis rate was 14.3%. Fisher's exact test showed a non-significant p-value of >0.99. We have achieved up to at 8 cm lift of the NAC using this technique with a complication rate comparable to more classical incisions. We propose that NSM incision should be chosen based on an individualised approach by considering oncological resection, degree of ptosis and planned reconstruction.