# Initial Outcomes of a Novel Technique of Nipple Sparing Mastectomy Without Reconstruction

## TL;DR

A new mastectomy technique called Minimal Scar Mastectomy (MSM) is safe and has good cosmetic results, especially when avoiding risk factors like prediabetes.

## Contribution

This is the first study on the outcomes of Minimal Scar Mastectomy (MSM), a novel technique that avoids reconstruction and transverse scarring.

## Key findings

- MSM showed no recurrence after a median follow-up of 41 months, indicating it is oncologically safe.
- Nipple necrosis was more likely in patients with prediabetes and MRD ≥1.5 cm.
- Cosmetic outcomes were rated as excellent/good by 73.3% of patients, improving to 90.9% when risk factors were avoided.

## Abstract

Nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to also conserve their nipple and avoid the transverse scar associated with mastectomy and no reconstruction. This is the first study on the initial oncologic and surgical outcomes of MSM. MSM was oncologically safe with no recurrence after a median follow-up of 41 months. Nipple necrosis was more likely in patients with risk factors including prediabetes and with a greater amount of breast skin for reduction during mastectomy, measured as MRD (mean ring distance) ≥1.5 cm. Excluding the cases with risk factors, nipple necrosis was 9%, which is compatible with the literature. The majority rated the cosmetic outcome as excellent/good. These pilot results will refine the selection criteria of patients for MSM.

Introduction: Nipple sparing mastectomy is oncologically safe and has a good cosmetic outcome. However, nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to conserve their nipple areolar complex (NAC) and avoid the transverse scar associated with modified radical mastectomy. This is the first study on the outcomes of MSM. Methods: MSM complications and their risk factors, recurrence rates and cosmetic outcomes were assessed. As MSM is a modification of the round block technique, the mean ring distance (MRD), which is the average of the distance between the inner and outer ring circumferentially, was assessed, too. Results: A total of 28 patients (29 breasts) were analysed. There was no recurrence after a mean/median follow-up of 40.3/41 months (4–80 months). In the initial recruitment of 17 patients (18 breasts), NAC necrosis occurred in eight cases (three complete, five partial). Prediabetes (p = 0.0128) and MRD ≥1.5 cm (p = 0.0440) were statistically significant for NAC necrosis. Of the available data, 11/15 (73.3%) rated the cosmetic outcome as excellent/good, with poorer cosmetic outcome correlated with NAC necrosis (p = 0.006). Avoiding the above risk factors in the next 11 patients, NAC necrosis decreased to 1/11 (9.0%) with mild ischaemia. Cosmetic outcome was rated as excellent/good in 90.9%. Conclusions: MSM is oncologically safe and is best performed in patients with no risk factors for NAC necrosis, including prediabetes and MRD < 1.5 cm. These pilot results will refine the selection criteria of patients for MSM.