Breast Oncology

Annals of Surgical Oncology

, Volume 15, Issue 12, pp 3396-3401

Nipple-Sparing Mastectomy: Critical Assessment of 51 Procedures and Implications for Selection Criteria

  • Anna M. VolturaAffiliated withDivision of Surgical Oncology, Department of Surgery, Johns Hopkins University
  • , Theodore N. TsangarisAffiliated withDivision of Surgical Oncology, Department of Surgery, Johns Hopkins University Email author 
  • , Gedge D. RossonAffiliated withDivision of Plastic Surgery, Department of Surgery, Johns Hopkins University
  • , Lisa K. JacobsAffiliated withDivision of Surgical Oncology, Department of Surgery, Johns Hopkins University
  • , Jaime I. FloresAffiliated withDivision of Plastic Surgery, Department of Surgery, Johns Hopkins University
  • , Navin K. SinghAffiliated withDivision of Plastic Surgery, Department of Surgery, Johns Hopkins University
  • , Pedram ArganiAffiliated withDepartment of Pathology and Oncology, Johns Hopkins University
  • , Charles M. BalchAffiliated withDivision of Surgical Oncology, Department of Surgery, Johns Hopkins University

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Abstract

Background

Retrospective studies have shown that occult nipple–areolar complex (NAC) involvement in breast cancer is low, occurring in 6–10% of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-sparing mastectomy (NSM) has prompted further evaluation of the oncologic safety of this procedure.

Methods

We conducted a retrospective chart review of 36 self-selected patients who underwent 51 NSM procedures between 2002 and 2007. Criterion for patient selection was no clinical evidence of nipple–areolar tumor involvement. All patients had the base of the NAC evaluated for occult tumor by permanent histologic section assessment. We also evaluated tumor size, location, axillary node status, recurrence rate, and cosmetic result.

Results

Malignant NAC involvement was found in 2 of 34 NSM (5.9%) completed for cancer which prompted subsequent removal of the NAC. Of the 51 NSM, 17 were for prophylaxis, 10 for ductal carcinoma in situ (DCIS), and 24 for invasive cancer. The average tumor size was 2.8 cm for invasive cancer and 2.5 cm for DCIS. Nine patients had positive axillary nodes. Overall, 94% of the tumors were located peripherally in the breast. After mean follow-up of 18 months, only two patients (5.9%) had local recurrence.

Conclusion

Using careful patient selection and careful pathological evaluation of the subareolar breast tissue at surgery, NSM can be an oncologically safe procedure in patients where this is important to their quality of life. A prospective study based on focused selection criteria and long-term follow-up is currently in progress.