# Usefulness of the Nipple Delay Procedure in Nipple-Sparing Mastectomy

## TL;DR

The Nipple Delay procedure helps prevent nipple complications in a breast surgery called Nipple-Sparing Mastectomy, especially in high-risk patients.

## Contribution

The study demonstrates the effectiveness of the Nipple Delay procedure in reducing ischemic complications during Nipple-Sparing Mastectomy.

## Key findings

- No cases of full-thickness necrosis requiring NAC excision were observed.
- Partial-thickness necrosis occurred in 20% of patients but healed with conservative treatment.
- The ND procedure safely expands NSM indications, even in high-risk patients.

## Abstract

Background/Objectives: Nipple-sparing mastectomy (NSM) is a surgical procedure that significantly improves postoperative cosmetic outcomes and quality of life (QOL) while ensuring oncological safety. However, ischemic necrosis of the nipple–areolar complex (NAC), resulting from impaired blood flow, remains a serious complication, particularly in patients with risk factors. To mitigate this ischemic risk, the Nipple Delay (ND) procedure, which applies the principle of surgical delay, has been proposed. The objective of this study was to retrospectively review cases in which the ND procedure was performed prior to NSM with immediate autologous breast reconstruction and to evaluate the safety and clinical utility of this technique in preventing NAC necrosis. Methods: This study included 30 breasts from 30 patients who underwent the ND procedure prior to NSM with autologous reconstruction at our institution. ND was performed under local anesthesia two weeks before NSM. The skin around the NAC was dissected from the underlying breast tissue. Results: The median age of the patients was 49 years, and the mean BMI was 22.7 kg/m2. Risk factors for NAC necrosis included periareolar incision in 24 patients (80.0%), a BMI of 25 kg/m2 or higher in 7 patients (23.3%), and a history of smoking in 8 patients (26.7%). No cases of full-thickness necrosis requiring NAC excision were observed (0%). Partial-thickness necrosis, which healed with conservative treatment, was observed in 6 patients (20.0%). No malignant involvement was detected in subareolar specimens. Conclusions: A staged approach using the ND procedure before NSM suggests effectiveness for preventing serious ischemic complications and safely expanding the indications for NSM, even in patients at high risk of NAC necrosis.