Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Background: Nipple-sparing mastectomy (NSM) allows for preservation of the entire nipple-areola complex utilizing various incision patterns. Reconstructive trends and overall risk associated with these diverse NSM incisions have yet to be fully elucidated. Methods: All NSMs from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar. Results: A total of 1212 NSMs were performed with 1207 NSMs included for final analysis. Of these, 638 (52.9%) utilized an inframammary fold incision, 294 (24.4%) utilized a lateral radial incision, 161 (13.3%) used a vertical radial incision, 60 (5.0) utilized a Wise pattern incision, 35 (2.9%) used a previous incision, and 19 (1.6%) utilized a periareolar incision. The groups were heterogeneous and differed significantly with regards to various factors including age (p