Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to-Inframammary Fold Measurement.
Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to-Inframammary Fold Measurement.
- 2020
BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included 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: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm.
English
0032-1052
00006534-202002000-00006 [pii] 10.1097/PRS.0000000000006439 [doi]
*Breast Neoplasms/su [Surgery]
*Breast Neoplasms/su [Surgery]
*Ischemia/et [Etiology]
*Ischemia/et [Etiology]
*Mastectomy/mt [Methods]
*Mastectomy/mt [Methods]
*Nipples/su [Surgery]
*Nipples/su [Surgery]
*Organ Sparing Treatments/mt [Methods]
*Organ Sparing Treatments/mt [Methods]
Adult
Adult
Aged
Aged
Female
Female
Humans
Humans
Incidence
Incidence
Ischemia/ep [Epidemiology]
Ischemia/ep [Epidemiology]
Logistic Models
Logistic Models
Mastectomy/ae [Adverse Effects]
Mastectomy/ae [Adverse Effects]
Middle Aged
Middle Aged
Organ Sparing Treatments/ae [Adverse Effects]
Organ Sparing Treatments/ae [Adverse Effects]
Postoperative Complications/et [Etiology]
Postoperative Complications/et [Etiology]
Regression Analysis
Regression Analysis
Risk Factors
Risk Factors
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article
BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included 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: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm.
English
0032-1052
00006534-202002000-00006 [pii] 10.1097/PRS.0000000000006439 [doi]
*Breast Neoplasms/su [Surgery]
*Breast Neoplasms/su [Surgery]
*Ischemia/et [Etiology]
*Ischemia/et [Etiology]
*Mastectomy/mt [Methods]
*Mastectomy/mt [Methods]
*Nipples/su [Surgery]
*Nipples/su [Surgery]
*Organ Sparing Treatments/mt [Methods]
*Organ Sparing Treatments/mt [Methods]
Adult
Adult
Aged
Aged
Female
Female
Humans
Humans
Incidence
Incidence
Ischemia/ep [Epidemiology]
Ischemia/ep [Epidemiology]
Logistic Models
Logistic Models
Mastectomy/ae [Adverse Effects]
Mastectomy/ae [Adverse Effects]
Middle Aged
Middle Aged
Organ Sparing Treatments/ae [Adverse Effects]
Organ Sparing Treatments/ae [Adverse Effects]
Postoperative Complications/et [Etiology]
Postoperative Complications/et [Etiology]
Regression Analysis
Regression Analysis
Risk Factors
Risk Factors
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article