ASO Author Reflections: Nipple-Sparing Mastectomy with Prepectoral Versus Submuscular Reconstruction: Postoperative Complications

Excerpt

Nipple-sparing mastectomy (NSM) was introduced as a surgical oncology technique in the early 2000s and quickly gained popularity due to improvement in aesthetic outcomes and demonstrated oncologic safety.1,2 Breast reconstruction in the immediate setting has evolved over time alongside NSM. Traditionally, this operation was performed in the submuscular (SM) plane, whereby the plastic surgeon elevated the pectoralis major and serratus to place the tissue expander in a submuscular pocket. Subsequently acellular dermal matrix (ADM) was introduced as a sling to cover the inferior pole of the implant after releasing the pectoralis major, creating a larger reconstructive pocket at the time of mastectomy and expanding the options for reconstruction.3 With modern advances in implants and ADM, the historically described prepectoral (PP) reconstructive approach is now being revisited.4,5 This technique is associated with improvements in cosmetic outcomes, decreased postoperative pain, elimination of animation deformity, reduced capsular contracture with radiation, and similar infection and wound healing rates when compared with SM reconstruction.6,7 Despite these advantages, some surgeons have been reluctant to adopt the PP approach in NSM cases, citing concern about the nipple–areolar complex overlying nonvascular ADM rather than perfused muscle. Critics hypothesized that this could result in increased complications (ischemia and necrosis), leading to higher rates of implant exposure, infection, and loss of reconstruction with the PP approach following NSM. …