Which Has Fewer Complications: Minimal Access or Conventional Nipple-Sparing Mastectomy?

By: Victoria Kuhr, MS
Posted: Friday, August 30, 2024

A retrospective, multicenter Korean study found similar complication rates between conventional nipple-sparing mastectomy (NSM) and minimal access NSM, with both methods being equally safe for patients based on their specific needs. However, Hyung Seok Park, MD, PhD, of Yonsei University College of Medicine, Seoul, Republic of Korea, and Jeeyeon Lee, MD, PhD, of Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea, observed that minimal access NSM showed advantages over conventional NSM, such as a significantly lower incidence of nipple-areolar complex (NAC) necrosis and seroma and a shorter incision. These findings were published in JAMA Surgery.

This study included female patients (aged 19 and older) with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. A total of 1,583 female patients were enrolled in the study, with a mean age of 45.8 years. Of them, 1,356 underwent conventional NSM, and 227 underwent minimal access NSM (35 endoscopy-assisted and 192 robot-assisted).

No significant difference between the two groups was reported regarding short- and long-term postoperative complications 30 days and 90 days after surgery (< 30 days: P = .53; < 90 days: P = .06). NAC necrosis was more common long term after conventional NSM than after minimal access NSM (6.7% vs 2.2%, respectively; P = .04). Wound infection occurred more frequently after minimal access than conventional NSM (7.9% vs 4.3%, respectively; P = .03). Postoperative seroma occurred more frequently after conventional NSM (14.2% vs 9.3%, respectively; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis. Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (P = .01).

Disclosure: Dr. Lee reported no conflicts of interest. For full disclosures of the other study authors, visit jamanetwork.com.

JAMA Surgery