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

Abstract

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 undergoing mastectomy plus immediate implant reconstruction from 09/2021-12/2022 using electronic health records from two hospitals. The relative risk 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%). Surgical site infection occurred in 49 (13.9%) women within 180 days after surgery, while 70 (19.9%) women developed an SSI and/or noninfectious wound complication. Although the incidence of SSI and the composite SSI/NIWC outcome were 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 1.26-3.59) and SSI/NIWC (RR 2.19, 95% CI 1.40-3.43).

Conclusions: Nipple-sparing mastectomy was associated with increased risk of both SSI and noninfectious wound complications 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 pre-surgical counseling to facilitate shared decision making.