Nipple or skin-sparing mastectomy flap: can preoperative breast-MRI predict post-operative complications?

BACKGROUND: This study aimed to evaluate the role of skin flap thickness (SFT), measured by preoperative breast magnetic resonance imaging (MRI), in predicting postoperative complications after nipple-sparing or skin-sparing mastectomy, and to assess its value in guiding reconstructive strategy selection. METHODS: We conducted a retrospective single-center study including patients who underwent preoperative breast MRI and nipple-sparing or skin-sparing mastectomy for breast cancer or BRCA1/2 mutations between January 2019 and August 2025. Demographic, clinical, and perioperative data were collected. Patients were stratified into two groups based on mean preoperative SFT: >8 mm (Group A) and <8 mm (Group B). Postoperative complications were recorded and analyzed using univariate and multivariate models. RESULTS: Sixty patients (mean age 47.5 ± 9.1 years) and 80 breasts (40 unilateral, 20 bilateral procedures) were included. Group A comprised 54 breasts (67.5%), while Group B included 26 (32.5%). Postoperative hospital stays and incision type differed significantly between groups (p < 0.05). Overall postoperative morbidity was 16.25%. Partial nipple-areola complex necrosis (11.5%) and hematoma (7.7%) occurred significantly more often in Group B compared to Group A (both p < 0.05). Multivariate analysis confirmed preoperative SFT <8 mm as an independent predictor of these complications (odds ratio 13.40, p = 0.012). CONCLUSION: Preoperative magnetic resonance imaging assessment of skin flap thickness reliably identifies patients at increased risk of postoperative complications. Integrating this parameter into surgical planning may support personalized reconstructive decision-making and improve clinical outcomes.