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. 2025 Jan;32(1):98-103.
doi: 10.1245/s10434-024-16329-y. Epub 2024 Oct 14.

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy

Xuanji Wang  1 , Jordan Jackson  2 , Christina Weed  3 , Marissa K Boyle  2 , Farin F Amersi  2 , James Mirocha  2 , Armando E Giuliano  2 , Alice P Chung  2
Affiliations

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy

Xuanji Wang et al. Ann Surg Oncol. 2025 Jan.

Abstract

Background: Nipple delay (ND) is a staged procedure that improves nipple-areolar complex (NAC) viability in nipple-sparing mastectomy (NSM) patients who are high-risk for NAC or skin-flap necrosis. This study compared postoperative outcomes and risk factors between patients treated with ND-NSM and NSM alone.

Methods: Patient demographics, risk factors for NAC or skin-flap necrosis, tumor characteristics, and operative outcomes were compared between ND-NSM and NSM groups from 2009 to 2023. Univariate and multivariate analyses were performed to identify significant variables associated with NAC or skin-flap necrosis.

Results: Overall, 71 ND-NSM patients and 537 NSM patients were compared. ND-NSM patients had larger breasts (p < 0.01), body mass index ≥ 30 (p = 0.01), prior breast/chest wall radiation (XRT) [p < 0.01], prior breast operations (p < 0.01), less axillary surgery (p < 0.01), more autologous tissue reconstruction over implant-based reconstruction compared with NSM patients (p = 0.02), and more prophylaxis (p < 0.01). There were no statistically significant differences between groups in regard to infection, skin-flap necrosis, NAC necrosis, seromas, and hematomas. No patients in the ND-NSM group had NAC necrosis and 1 patient had skin-flap necrosis, compared with 17 and 13 patients in the NSM group, respectively (p = 0.24). On univariate analysis, prior XRT was associated with increased risk for skin-flap necrosis (p = 0.02). Multivariate analysis showed XRT was associated with skin-flap necrosis (p = 0.02) and any necrosis (p = 0.01). Breast size was associated with NAC or skin-flap necrosis (p = 0.04).

Conclusion: Larger breasts and XRT were risk factors for NAC or skin-flap necrosis; however, despite having more risk factors, ND-NSM patients had very low rates of necrosis. Notably, no nipples were lost. A shared decision should be made with patients regarding the risks and benefits of ND-NSM.

Keywords: Breast cancer; Nipple delay; Nipple-areolar complex necrosis; Nipple-sparing mastectomy; Skin-flap necrosis; Surgical outcome.

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Conflict of interest statement

Disclosures: Xuanji Wang, Jordan Jackson, Christina Weed, Marissa K. Boyle, Farin F. Amersi, James Mirocha, Armando E. Giuliano, and Alice P. Chung have no commercial interests to declare that may be relevant to the contents of this study.

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