Abstract Objective Nipple‐areolar complex (NAC) necrosis is a significant complication of nipple‐sparing mastectomy (NSM). Identifying modifiable risk factors is critical to improving surgical safety and cosmetic results. Methods We conducted a retrospective study of 78 subjects with a total of 83 NSMs with immediate reconstruction performed for breast cancer in Kwong Wah Hopsital, Hong Kong. Correlations between NAC necrosis and potential risk factors were investigated. Univariate logistic regression identified potential predictors, which were subsequently entered into a multivariable regression model. Results NAC necrosis occurred in 29 cases (34.9%), including 4 (4.8%) complete necrosis. Nine cases (10.8%) required a second operation for wound management. The mean age was 50.2 years (range 32–66 years). Pedicled transverse rectus abdominis myocutaneous (TRAM) flap was the most common reconstructive method (71.1%). Endoscopic assistance was utilized in 48.2% of cases. Two independent predictors for NAC necrosis were identified in the multivariable regression model: smoking (OR 6.858, p = 0.046) and endoscopic assistance, which was protective (OR 0.335, p = 0.050). Prior ipsilateral breast surgery (OR 23.750, p = 0.010) is a significant risk factor for re‐operation for NAC necrosis. Conclusion Smoking increases the risk of NAC necrosis, while endoscopic‐assisted NSM is shown to be protective. Prior surgery in the ipsilateral breast increases risk of re‐operations in cases with NAC necrosis.
Lo et al. (2026) studied this question.