Incision choice in nipplesparing mastectomy: submammary or periareolar?

Subcutaneous mastectomy with nipple preservation and immediate implant reconstruction has become the preferred surgical procedure, providing good aesthetic outcomes and high patient satisfaction. However, ischemia and necrosis of the nippleareolar complex (NAC) remain significant postoperative complications. The choice of incision type may affect both the aesthetic result and the complication rate.
The aim of this study is to compare early postoperative complications after subcutaneous mastectomy with NAC preservation, depending on the incision type: submammary versus periareolar.
Materials and methods. A retrospective singlecenter analysis of complications in patients who underwent subcutaneous mastectomy with NAC preservation and immediate implant reconstruction for therapeutic or riskreducing purposes between 2021 and 2024.
Results. A total of 231 operations were performed in 155 patients (bilateral mastectomy in 76 cases): 204 patients underwent surgery with a submammary incision, and 27 patients – with a periareolar incision. The mean age was higher in the periareolar group (43,3 vs. 39,4 years; p=0,005), as was the implant volume (384 cm³ vs. 333 cm³ ; p=0,003). A total of 83 complications (35.9%) were recorded: 17 (63%) in the periareolar group and 66 (32%) in the submammary group (p=0,003). NAC necrosis accounted for 15 (55.6%) complications in the periareolar group versus 14 (6.9%) in the submammary group (p<0,001). The incidence of marginal NAC necrosis was 9 (33.3%) in the periareolar group and 11 (5.4%) in the submammary group (p<0,001). The incidence of total NAC necrosis was 6 (22.2%) in the periareolar group and 3 (1.5%) in the submammary group (p<0,001).
Conclusion. The submammary incision is a more preferable approach for subcutaneous mastectomy with NAC preservation, as it is associated with a lower complication rate.

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