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

Abstract

Introduction 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). Materials and methods We performed a retrospective review of all patients undergoing hemi-Y NSM with immediate implant-based reconstruction at a tertiary centre between November 2009 and December 2019. Data collected included demographics, comorbidities, oncological treatments, operative details, peri-operative complications, and long-term outcomes. Results 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. Conclusion The hemi-Y incision provides adequate access for NSM and implant reconstruction with low complication rates and favourable 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 optimising aesthetic outcomes following conservative mastectomy and implant-based reconstruction.