Reducing complications and margin issues with nipple-sparing mastectomy

Abstract

Nipple-sparing mastectomy (NSM) followed by immediate reconstruction is associated with low morbidity and mortality rates. The most concerning complication is skin and nipple necrosis which can lead to patient dissatisfaction and ultimately loss of reconstruction. Patient selection plays a key role in minimizing complications. This chapter describes the most common complications associated with NSM and patient as well as technical factors that may be predictive of these complications. The various techniques for minimizing and managing nipple or flap necrosis are discussed. In addition, positive margin status after NSM presents concerns regarding need for reoperation with possible removal of the NAC as well as risk for local recurrence. This chapter will address incidence of close or positive margins following NSM, techniques to accurately assess retro-areolar margin status, management of positive margins, the potential role of post-mastectomy radiation in patients with close or positive margins and rates of local recurrence following NSM.