• Author
    Chris Zhao
  • Discovery PI

    Michael DeLong MD

  • Project Co-Author

    Alaina Matthews, Arielle Grieco, Yixin Wu, Yasmine Ibrahim, Jose Segura-Bermudez, Maxwell Zywica

  • Abstract Title

    Nipple-Sparing Versus Non-Nipple-Sparing Mastectomy in Immediate Breast Reconstruction: A National Observational Cohort

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Background: Nipple-sparing mastectomy (NSM) offers aesthetic advantages, but concern persists that nipple preservation may increase mastectomy flap necrosis after immediate reconstruction.

    Methods: We performed a retrospective cohort study of women undergoing mastectomy with immediate reconstruction in the National Surgical Quality Improvement Program Breast Module from July 1, 2024, to August 10, 2025. Patients were grouped by mastectomy type (NSM versus non-NSM). Breast-level analyses were stratified by reconstruction type (autologous flap, tissue expander, or direct-to-implant). Multivariable logistic regression clustered by patient tested whether NSM independently predicted complications.

    Results: A total of 2,617 patients (4,387 breasts) met inclusion criteria. NSM patients were younger, had lower body mass index, were less likely to have hypertension, were more often bilateral, and were more often reconstructed with direct-to-implant techniques and mesh support. Complication rates were low. NSM was not independently associated with skin flap necrosis in flap-based (adjusted odds ratio [aOR], 1.24; 95% CI, 0.72-2.15), tissue-expander (aOR, 1.51; 95% CI, 0.94-2.44), or direct-to-implant reconstruction (aOR, 0.84; 95% CI, 0.54-1.30). In tissue-expander reconstruction, NSM had lower seroma rates (6.3% versus 15.2%) and remained independently associated with lower seroma odds (aOR, 0.41; 95% CI, 0.28-0.60).

    Conclusions: In this contemporary national cohort, NSM accounted for half of immediate reconstructions and did not increase 30-day mastectomy flap necrosis or other major early complications after adjustment. Nipple preservation itself does not appear to impose an early reconstructive penalty in appropriately selected patients.

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