Hemi-Y incision for nipple-sparing mastectomy with immediate implant reconstruction: 10-year outcomes from a single-center series

TL;DR

A 10-year study shows the hemi-Y incision for nipple-sparing mastectomy with implant reconstruction has low complications and good long-term outcomes.

Contribution

The study presents a 10-year follow-up of a specific incision technique for NSM with implant reconstruction, demonstrating its safety and effectiveness.

Findings

The hemi-Y incision had a 15% early complication rate with no NAC necrosis or implant loss.

A 10-year implant survival rate of 89% was observed with no local or NAC recurrences.

The technique is suitable for small- to moderate-sized breasts and provides good scar concealment.

Abstract

Nipple-sparing mastectomy (NSM) is increasingly performed for both risk-reducing and therapeutic indications, with oncological outcomes comparable to conventional mastectomy and improved aesthetic outcomes. Several incision patterns have been described, with no single approach universally preferred. The hemi-Y incision combines a limited peri‑areolar component (25% of the circumference) with an inferior radial extension from 6 o’clock, providing adequate exposure for mastectomy and implant placement in appropriately selected cases, while partially concealing the scar along the nipple–areola complex (NAC).

We performed a retrospective review of all patients undergoing hemi-Y NSM with immediate implant-based reconstruction at a tertiary center between November 2009 and December 2019. Data collected included demographics, comorbidities, oncological treatments, operative details, peri‑operative complications, and long-term outcomes.

Eleven patients (20 breasts) underwent hemi-Y NSM with immediate implant reconstruction. The cohort comprised predominantly risk-reducing procedures, with one case of ductal carcinoma in situ and no invasive carcinomas. Complete 10-year follow-up was available for nine patients (18 breasts); two patients (4 breasts) were lost to follow-up. Early complications occurred in 3 breasts (15%): one superficial wound dehiscence, one seroma, and one infection with wound breakdown. There were no cases of nipple-areola complex (NAC) or mastectomy skin-flap necrosis, or peri‑operative implant loss. Over 10 years, three patients (15%) required implant revision or exchange, giving a 10-year implant survival rate of 89% (16/18 breasts). No local or NAC recurrences were observed. One patient developed brain metastases at 10 years, while all remaining patients were alive and disease-free.

The hemi-Y incision provides adequate access for NSM and implant reconstruction with low complication rates and favorable scar concealment. Ten-year follow-up confirms durable reconstructive and oncological outcomes, supporting its role as a practical and reproducible option for patients undergoing NSM with implant reconstruction, predominantly in the risk-reducing and ductal carcinoma in situ (DCIS) setting. It should be considered in patients with small- to moderate-sized, non-ptotic breasts as a viable option for optimizing aesthetic outcomes following conservative mastectomy and implant-based reconstruction.

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