Display options
Share it on

Gland Surg. 2015 Dec;4(6):528-40. doi: 10.3978/j.issn.2227-684X.2015.04.12.

Nipple areola complex sparing mastectomy.

Gland surgery

Camilla Rossi, Matteo Mingozzi, Annalisa Curcio, Federico Buggi, Secondo Folli

Affiliations

  1. Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy.

PMID: 26645007 PMCID: PMC4647000 DOI: 10.3978/j.issn.2227-684X.2015.04.12

Abstract

Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes.

Keywords: Breast cancer (BC); breast conservation; breast surgery; mastectomy; outcome

References

  1. Plast Reconstr Surg. 2009 Jun;123(6):1665-73 - PubMed
  2. Am J Surg Pathol. 1980 Dec;4(6):543-9 - PubMed
  3. Aesthetic Plast Surg. 2004 Nov-Dec;28(6):393-8 - PubMed
  4. Lancet. 2005 Dec 17;366(9503):2087-106 - PubMed
  5. Ann R Coll Surg Engl. 1959 Nov;25:235-51 - PubMed
  6. J Am Coll Surg. 2006 Nov;203(5):704-14 - PubMed
  7. Ann Plast Surg. 2012 Oct;69(4):425-8 - PubMed
  8. Am J Surg. 2007 Oct;194(4):433-7 - PubMed
  9. Br J Surg. 1987 Jan;74(1):58-61 - PubMed
  10. J Natl Cancer Inst. 2000 Sep 6;92(17):1422-9 - PubMed
  11. Gland Surg. 2012 Aug;1(2):75-9 - PubMed
  12. Ann Plast Surg. 2005 Sep;55(3):240-4 - PubMed
  13. Am J Surg. 2015 Jan;209(1):212-7 - PubMed
  14. Plast Reconstr Surg. 1998 Jun;101(7):2009-10 - PubMed
  15. Ann Surg. 2010 Mar;251(3):493-8 - PubMed
  16. Ann Surg Oncol. 2012 Apr;19(4):1174-80 - PubMed
  17. Plast Reconstr Surg. 2013 May;131(5):969-84 - PubMed
  18. Aesthetic Plast Surg. 2009 Sep;33(5):681-6 - PubMed
  19. Plast Reconstr Surg. 2006 Apr;117(4):1083-90 - PubMed
  20. Eur J Surg Oncol. 2008 Feb;34(2):143-8 - PubMed
  21. Histopathology. 2013 Jul;63(1):143-6 - PubMed
  22. J Am Coll Surg. 2015 May;220(5):e65-9 - PubMed
  23. Lancet Oncol. 2012 Jul;13(7):e311-7 - PubMed
  24. Breast Cancer Res Treat. 2009 Dec;118(3):623-33 - PubMed
  25. Cancer. 2010 Mar 1;116(5):1184-91 - PubMed
  26. Ann Surg Oncol. 2008 May;15(5):1341-7 - PubMed
  27. Ann Surg Oncol. 2011 Apr;18(4):917-22 - PubMed
  28. Gland Surg. 2014 Nov;3(4):252-7 - PubMed
  29. Ann Surg Oncol. 2002 Mar;9(2):165-8 - PubMed
  30. Surg Oncol. 2008 Dec;17(4):261-6 - PubMed
  31. Br J Surg. 2010 Mar;97(3):305-16 - PubMed
  32. Aesthetic Plast Surg. 1987;11(1):45-8 - PubMed
  33. Breast J. 2013 Mar-Apr;19(2):173-9 - PubMed
  34. Ann Surg. 2009 Mar;249(3):461-8 - PubMed
  35. Br J Plast Surg. 1986 Jul;39(3):287-99 - PubMed
  36. Ann Surg Oncol. 2012 Oct;19(10):3171-6 - PubMed
  37. Ann Surg. 2003 Jul;238(1):120-7 - PubMed
  38. Breast J. 2005 May-Jun;11(3):173-8 - PubMed
  39. Updates Surg. 2013 Dec;65(4):289-94 - PubMed
  40. J Natl Cancer Inst. 1973 May;50(5):1111-8 - PubMed
  41. Ann Oncol. 2012 Aug;23(8):2053-8 - PubMed
  42. J Am Coll Surg. 2007 May;204(5):1074-8; discussion 1078-80 - PubMed
  43. Ann Surg Oncol. 2011 Jun;18(6):1665-70 - PubMed
  44. Pathol Res Pract. 1980;166(4):515-35 - PubMed
  45. Ann Surg. 2009 Jan;249(1):26-32 - PubMed
  46. Surg Gynecol Obstet. 1976 Oct;143(4):546-8 - PubMed
  47. Breast. 2009 Feb;18(1):47-54 - PubMed
  48. World J Surg. 2006 Aug;30(8):1410-3 - PubMed
  49. Eur J Surg Oncol. 2001 Sep;27(6):521-6 - PubMed
  50. Breast. 2008 Feb;17(1):8-11 - PubMed
  51. Breast J. 2009 Jul-Aug;15(4):440-9 - PubMed
  52. Ann Surg Oncol. 2008 Feb;15(2):438-42 - PubMed
  53. Breast. 2012 Apr;21(2):190-3 - PubMed
  54. Can J Plast Surg. 2011 Winter;19(4):129-33 - PubMed

Publication Types