Revisiting the Anatomic Criteria in Nipple Sparing Mastectomy: The Midclavicle to Inframammary Fold Measurement
Cara K. Black, BA1, Kenneth L. Fan, MD1, Kyle Luvisa, BS1, Francis D. Graziano, MD2, Stephanie H.Y Lau3, David H. Song, MD, MBA, FACS1, Troy Pittman, MD1, Shawna C. Willey, MD1.
1Georgetown University, Washington, DC, USA, 2Mt Sinai Hospital, New York, NY, USA, 3Queen Elizabeth Hospital, Hong Kong, China.
Background: Anatomical exclusion criteria for nipple sparing mastectomy was defined as “not excessively large or ptotic breasts”. In this presentation, we refine our anatomical criteria with a novel midclavicle to inframammary fold(MCI) measurement for NSM performed through an inframammary approach. Methods: Retrospective review was performed on all NSM through an inframammary approach. Exclusion criteria include other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. Results: 140 breasts in 79 patients were obtained. Mastectomy weight was strongly correlated with MCI measurement on linear regression (R2=0.651, p<0.001) but not ptosis or sternal notch to nipple. Twenty five breasts(17.8%) had ischemic complications: 16(11.4%) were nonoperative and 9(6.4%) were operative. Those with mastectomy weights ≥500g were 9 times more likely to have operative ischemic complications than those with mastectomy weights <500g(p=0.0048). Those with MCI ≥30cm had a 3.8 times increased incidence of any ischemic complication(p=0.00547) and 9.2 times increase incidence of operative ischemic complications(p=0.00376) compared with those <30cm. Conclusion: Breasts undergoing NSM with inframammary approach with MCI measurement ≥30cm are at high risk for having ischemic complications. While our absolute contraindication to NSM remains MCI >34cm, consideration for a staged approach or lateral incision is warranted in those ≥30cm.
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