Circumferential periareolar incision length as a risk factor for skin necrosis after nipple-sparing mastectomy with deep inferior epigastric perforator flap reconstruction.

[BACKGROUND] Nipple-sparing mastectomy (NSM) with autologous tissue reconstruction offers excellent cosmetic outcomes but can be complicated by skin necrosis. This study aimed to investigate the risk factors for skin necrosis after NSM with deep inferior epigastric perforator (DIEP) flap reconstruction, focusing on the impact of circumferential periareolar incision length.

[METHODS] A retrospective review of 61 patients who underwent NSM followed by DIEP flap reconstruction between 2020 and 2023 was conducted. Data on patient demographics, breast characteristics, incision type, and skin necrosis outcomes were collected.

[RESULTS] The overall rate of the mastectomy skin flap or nipple-areola complex (NAC) was 42.6%. The length of the periareolar incision was significantly associated with the incidence of skin necrosis (p = 0.035). Patients with incisions exceeding 30% of the periareolar circumference had a higher risk of necrosis (57.1%) compared to those with shorter incisions (30.3%). No significant associations were found between skin necrosis and BMI, breast ptosis, patient age, year of reconstruction, or neoadjuvant chemotherapy.

[CONCLUSIONS] This study suggests that for patients undergoing NSM with DIEP flap reconstruction, a circumferential periareolar incision length exceeding 30% is associated with an increased risk of skin necrosis in the mastectomy skin flap or NAC. Surgeons should strive to minimize periareolar incision length while ensuring adequate access for flap vascular anastomosis.