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Delay Techniques for Nipple-Sparing Mastectomy: A Systematic Review
Laurel S. Karian, MD, Paul J. Therattil, MD, Philip D. Wey, MD, Kevin T. Nini, MD.
Rutgers - New Jersey Medical School, Newark, NJ, USA.

PURPOSE:
Complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) or mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications, and may be combined with retroareolar biopsy when performed prior to NSM. We performed a systematic review of the literature to evaluate techniques for NAC and mastectomy flap delay. METHODS:
PubMed and Cochrane databases were searched from 1975 through 2016. The following search terms were used as both subjects and key words: ‘nipple sparing mastectomy’ AND (‘delay’ OR ‘stage’ OR ‘staged’). Two independent reviewers determined study eligibility, accepting only studies reporting objective results involving patients who underwent a delay procedure prior to NSM. RESULTS:
The literature search yielded 242 studies, of which five met inclusion criteria, with a total of 101 patients. Partial NAC necrosis was reported in 9 patients (8.9%), and mastectomy flap necrosis was reported in 8 patients (7.9%). Three of the five studies reported positive retroareolar biopsy findings in 7 patients (6.9%). CONCLUSION: This systematic review represents all the available literature on delay procedures prior to NSM. These procedures may be considered in patients at risk for NAC or mastectomy skin flap necrosis, such as patients with pre-existing breast scars, active smoking, prior radiation, or nipple ptosis. Delay procedures have the added benefit of allowing a retroareolar biopsy to be sent for permanent sections prior to mastectomy, allowing the surgical team to plan for removal of the NAC at the time of mastectomy if indicated.


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