Venous Injury Linked to Nipple Necrosis After Nipple-Sparing Mastectomy

A cadaveric study and prospective cohort of 123 breasts undergoing nipple-sparing mastectomy with immediate implant-based reconstruction examined whether venous injury contributes to nipple-areolar complex (NAC) necrosis. The study reported that clinically significant NAC necrosis occurred in 15.4% of breasts and was associated with greater vein branch loss (quantified via near-infrared imaging), higher mastectomy weight, higher BMI, and diabetes, with the effect of vein branch loss increasing alongside mastectomy weight. The authors state that a prediction model combining these factors showed strong discrimination and identified a low-risk subset among breasts with poor indocyanine green angiography perfusion in which no significant necrosis occurred.

Most relevant for: Patients undergoing nipple-sparing mastectomy with immediate implant-based breast reconstruction, particularly those with higher BMI, diabetes, or larger mastectomy specimens.

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