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Nipple-Sparing Mastectomy Causes More Complications than Skin-Sparing after Breast Reconstruction

May 13, 2025

Olsen MA, Nickel KB, Margenthaler JA, et al. Nipple-Sparing Mastectomy and Infection Risk after Immediate Breast Reconstruction. J Am Coll Surg. 2025, in press.

Bayley EM. Nipple-Sparing Mastectomy, Informed Consent, and Shared Decision-Making. J Am Coll Surg. 2025, in press.

Nearly 40% of women who have mastectomy for treatment of breast cancer undergo immediate breast reconstruction with a breast implant or autologous tissue reconstruction. Skin sparing mastectomy (SSM) is the most common procedure, but there is increasing use of nipple-sparing mastectomy (NSM) to improve cosmetic outcomes.

Available evidence suggests that NSM is associated with an increased risk for wound complications leading to implant removal. This study sought to quantify the risk of surgical site infection (SSI) and overall wound complications in women (n = 352) who underwent mastectomy with immediate implant reconstruction. The primary outcome of interest was a composite of return to the operating room for treatment of a wound infection or wound complication during the first 180 postoperative days.

Nipple sparing mastectomy was performed in 36.4% of the cohort. The composite outcome was observed in 21.1% of the NSM group and 19.9% of the SSM group. After patient risk factor matching using multivariable statistical analysis, the risk of SSI and wound complications was found to be significantly higher in NSM group.

The authors recommended that risk of infection be included in preoperative discussions with patients being considered for NSM or SSM. In the editorial that accompanied the article, Bayley agreed with this recommendation.

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