“Nipple-sparing” techniques are safe and effective for mastectomy followed by immediate breast reconstruction, according to a new study in the March issue of Plastic and Reconstructive Surgery®.

Between 2007 and 2012, researchers from Massachusetts General Hospital in Boston performed a total of 500 nipple-sparing mastectomies in 285 women with an average age 46 years. Fifty-four percent of the women underwent prophylactic mastectomy because of their high genetic risk of breast cancer.

 Nearly all of the women underwent immediate breast reconstruction, usually with implants. In about 60% of patients, breast reconstruction with implants was completed at the same time as mastectomy. Most of the remaining women underwent two-stage reconstruction, including tissue expansion to increase the amount of skin available for implant-based reconstruction.

The overall complication rate was about 12%. The most common complications were necrosis of part of the nipple or skin used for reconstruction. Cancer involving the nipple area was discovered in another 4% of women. Even including these cases, the natural nipple was retained in the final reconstruction in more than 90% of cases.

The complication rate was more than three times higher for women who smoked. Women who had received radiation therapy were also at increased risk.

 Complications were also more common with periareolar incisions. In contrast, the more commonly used inframammary incision was associated with a lower complication rate.