Nipple Position and Clinical Outcomes Following Nipple-Sparing Mastectomy: An Examination of Prepectoral and Subpectoral Implant-Based Reconstruction Utilizing 3D Imaging.

Abstract

Nipple-sparing mastectomy (NSM) has become increasingly popular in recent years. However, the impact of prepectoral vs subpectoral implant reconstruction on nipple position, clinical outcomes, and patient-reported outcomes (PROs) after NSM remains unknown. We hypothesized that prepectoral reconstruction would lead to a more anatomic nipple position and improved clinical outcomes and PROs when compared to subpectoral reconstruction following NSM. Surgical characteristics, complications, and PROs in NSM patients with implant-based reconstruction from 2018 to 2021 were prospectively collected. Nipple displacement from baseline was analyzed with 3-dimensional (3D) surface imaging. In total 216 patients underwent 391 NSMs, separated into subpectoral (n = 96) and prepectoral (n = 120) cohorts. There were no differences in demographics or comorbidities between cohorts. Prepectoral placement showed a greater incidence of short-term return to the operating room (21% vs 10%, P = .026). Three-dimensional analysis of 96 patients and 175 nipple positions was conducted. Compared to preoperative baseline, 3D imaging at 12 months postoperatively showed that the subpectoral cohort had greater straight-line distance between the nipples (23.1 mm vs 17.3 mm, P < .001) and more lateral nipple displacement (9.2 mm vs 6.1 mm, P < .001) when compared to the prepectoral cohort. Regression analysis found no relationship between incision pattern and nipple displacement. No postoperative differences were seen in PROs. Subpectoral NSM reconstruction was found to have more lateralized nipple displacement when compared to prepectoral patients, regardless of the incision pattern employed. Nipple displacement after NSM can play a significant role in postoperative aesthetic appearance and should be considered when deciding implant plane.