Predictors of postoperative complications following staged nipple-sparing mastectomy: A systematic review & meta-analysis

Introduction: In ptotic breasts, patients can undergo breast reduction or mastopexy before nipple-sparing mastectomy (NSM) to improve the esthetic outcomes. Literature also suggests the benefit of staged nipple-sparing mastectomy (SNSM) on preserving the nipple-areolar complex (NAC). The aim of this study was to identify the predictors of postoperative complications after SNSM and consider whether shorter intervals between the stages are feasible. Methods: We reviewed MEDLINE and Embase for studies on SNSM outcomes, following the PRISMA guidelines. Key terms included "mastectomy," "mastopexy," and "nipple." Studies detailing surgical timelines and complications were included. Studies utilizing nipple grafting were excluded. Variables of interest included time between surgeries and complications such as NAC necrosis, infection, wound healing problems, seroma, hematoma, fat necrosis, and skin flap necrosis. Results: Eighteen studies were included for data extraction, encompassing 1085 breasts in 743 patients who received SNMS after breast-reducing mastectomy. The mean age was 46.1 +/- 2.3 years, and the mean BMI was 27.8 +/- 3.6 kg/m2. In studies with fewer than 12 months between surgeries, shorter intervals did not increase the odds of total complications (p = 0.272) or nipple-related complications (p = 0.457). Mastectomy weight positively correlated with complication odds, reaching borderline significant (B = 0.001, p = 0.05). In implant-based reconstructions, implant size significantly positively correlated with the odds of complications (B = 0.002, p = 0.046). Conclusions: Patient factors such as mastectomy weight and implant size were associated with higher complication rates. In studies of patients who underwent a second surgery within 12 months, no correlation was found between the interval between surgeries and complication likelihood, suggesting that a shorter interval may be safely considered. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).