Influence of the site of skin incision on the circulation in the nipple-areola complex after subcutaneous mastectomy in breast cancer

Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex in the surrounding skin. Sixty-nine patients invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a ''lazy-S''-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two dr three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (P < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.