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Expanding the use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction
Mallory A. Rowley, BA1, Prashant K. Upadhyaya, MD2 1College of Medicine, SUNY Upstate Medical University, Syracuse, NY 2Department of Surgery, SUNY Upstate Medical University, Syracuse, NY

Background: Wise-pattern closures are favored in obese patients undergoing staged implant-based reconstruction due to improved cosmesis through skin reduction. In contrast to the increased scarring of Wise-pattern closures, nipple-sparing mastectomies (NSM) offer the advantage of more concealed scarring, but are not popular in the obese population due to skin redundancy and the proposed risk of ischemic complications. This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population.

Methods: A retrospective chart review of obese patients (BMI >30) undergoing staged breast reconstruction following Wise-pattern and nipples-paring mastectomies at our institution (February 2016 to January 2020) was performed. Demographic, perioperative, and post-operative complication information was collected. Complication incidences between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test.

Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM) with a body mass index (BMI) > 30. Incidence of >1 complication in both the Wise-pattern and NSM cohorts was similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. There were no statistically significant differences between cohorts in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2. Mean BMI was significantly lower in the NSM cohort (32.6 vs 36.9, p < 0.0001) and the NSM cohort overall was significantly younger (46.4 vs 52.2 years of age, p = 0.0031).

Conclusion: There are no significant differences in postoperative complication rates between Wise-pattern closures and NSM in the obese population. While Wise-pattern closures address skin redundancy within this population, NSM can be appropriate in carefully selected patients and offer the advantage of less scarring.

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