Surgical delay may extend the indications for nipple-sparing mastectomy: A multicentric study

Emanuele Zarba Meli, Federico Cattin, Annalisa Curcio, E. Manna, Domenico Samorani, Daniela Tognali, Massimiliano Gennaro, Andrea Loreti, Secondo Folli, L. Fortunato

Research output: Contribution to journalArticlepeer-review


Introduction: Nipple-sparing mastectomy (NSM) is considered an oncologically sound procedure but necrosis of the nipple-areola complex (NAC) or skin flaps is a concern, particularly in the presence of risk factors. To increase the indications for NSM and decrease such complications, different procedures of “surgical delay” (SD) have been described. Materials and methods: A retrospective analysis of patients who underwent SD for NSM at four Italian Breast Centers from 2014 to 2017 was performed. SD generally consisted of a periareolar or “hemi-batwing” incision, dissecting the skin and the NAC from the underlying breast tissue. NSM was scheduled after 2–3 weeks. Results: Eighty-eight procedures were analyzed. Mild complications of SD were registered in 7.9% of cases. NSM was performed in 85 cases, whereas in three cases (3.4%) a “skin-sparing” mastectomy was necessary due to positivity of the retroareolar biopsy for cancer at SD. A direct-to- implant (DTI) reconstruction was performed in 42 cases (49.4%), while in 43 (50.6%) a tissue-expander (TE) was inserted. After NSM, eight complications (9.4%) were recorded: one total necrosis (1.2%), one partial necrosis (1.2%) and four minimal ischemia (4.7%) of NAC, one skin flap necrosis (1.2%), one haematoma (1.2%). In only two cases (2.3%) prosthesis removal was needed. Aesthetic outcome was evaluated excellent or good in 92.9% of cases. At a median follow-up of 24 months no local recurrences were seen. Conclusion: This is the largest series of SD with NSM presented so far in the literature. In our experience, SD extends indications for NSM in high-risk women.

Original languageEnglish
Pages (from-to)1373-1377
Number of pages5
JournalEuropean Journal of Surgical Oncology
Issue number8
Publication statusPublished - Aug 2019


  • Breast cancer
  • Nipple-sparing mastectomy
  • Plastic surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology


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