Skip to main content

Advertisement

SpringerLink
Log in

Surgical Delay of the Nipple–Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objectives

Nipple-sparing mastectomy (NSM) improves cosmetic outcome of mastectomy, but many patients are not candidates for this procedure because of concerns about nipple-areolar viability. Surgical delay is a technique that has been used for more than 400 years to improve survival of skin flaps. We used a surgical delay procedure to improve nipple viability in patients who were identified to be at high risk for nipple necrosis following NSM.

Methods

Patients at high risk for nipple necrosis following NSM underwent a surgical delay procedure 7–21 days prior to mastectomy. Subareolar biopsy and sentinel node biopsy, if indicated, were performed at the time of the delay procedure. Nipple viability was assessed before and after NSM. If the subareolar biopsy revealed malignancy, the NAC was removed at the time of mastectomy.

Results

31 NAC in 20 patients underwent surgical delay. All of the NAC subjected to a surgical delay survived following the delay procedure. In 2 patients, the subareolar biopsy was positive and 3 NAC were removed at the time of mastectomy (1 for purposes of symmetry). Of the 28 delayed NAC left at the time of NSM, all survived the post-mastectomy course.

Conclusion

A procedure to surgically delay the NAC 7–21 days prior to NSM is demonstrated to ensure viability of NAC in patients previously thought to be at high risk for nipple loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008;34:143–8.

    Article  PubMed  CAS  Google Scholar 

  2. Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areolar complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–7.

    PubMed  Google Scholar 

  3. Sacchini V, Pinotti JA, Barros A, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: Oncologic or technical problem? J Am Coll Surg. 2006;203:704–14.

    Article  PubMed  Google Scholar 

  4. Hinton CP, Doyle PJ, Blamey RW, Davies CJ, Holliday HW, Elston CW. Subcutaneous mastectomy for primary operable breast cancer. Br J Surg. 1984;71:469–72.

    Article  PubMed  CAS  Google Scholar 

  5. Jensen JA. When can the nipple-areolar complex safely be spared during mastectomy? Plast Reconstr Surg. 2002;109:805–7.

    Article  PubMed  Google Scholar 

  6. Jensen JA. Breast cancer: Is nipple-sparing mastectomy safe? Ann Surg. 2009;250:657.

    Article  PubMed  Google Scholar 

  7. Crowe JP Jr, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg. 2004;139:148–50.

    Article  PubMed  Google Scholar 

  8. Margulies AG, Hochberg J, Kepple J, Henry-Tillman RS, Westbrook K, Klimberg VS. Total skin sparing mastectomy without preservation of the nipple-areolar complex. Am J Surg. 2005;190:907–12.

    Article  PubMed  Google Scholar 

  9. Petit JY, Veronesi U, Orecchia R, et al. Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat. 2006;96:47–51.

    Article  PubMed  Google Scholar 

  10. Caruso F, Ferrara M, Castiglione G, Trombetta G, De Meo L, Catanuto G, Carillio G. Nipple sparing subcutaneous mastectomy: sixty-six months follow-up. Eur J Surg Oncol. 2006;32:937–40.

    Article  PubMed  CAS  Google Scholar 

  11. Garwood ER, Moore D, Ewing C, et al. Total skin sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249:26–32.

    Article  PubMed  Google Scholar 

  12. Vlajcic Z, Zic R, Stanec S, et al. Nipple-areolar complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 2005;55:240–4.

    Article  PubMed  CAS  Google Scholar 

  13. Stolier AJ, Sullivan SK, Dellacroce FJ. Technical considerations in nipple-sparing mastectomy: 82 consecutive cases without necrosis. Ann Surg Oncol. 2008;15:1341–7.

    Article  PubMed  Google Scholar 

  14. Jensen JA, Orringer JS, Giuliano AE. Nipple sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol. 2011;18:1665–70.

    Article  PubMed  Google Scholar 

  15. Ghali S, Butler PEM, Tepper OM, Gurtner GC. Vascular delay revisited. Plast Reconstr Surg. 2007;119:1735–44.

    Article  PubMed  CAS  Google Scholar 

  16. Jonsson K, Hunt TK, Brennan SS, Mathes SJ. Tissue oxygen measurements in delayed skin flaps: A reconsideration of the mechanisms of the delay phenomena. Plast Reconstr Surg. 1988;82:328–35.

    Article  PubMed  CAS  Google Scholar 

  17. Dhar SC, Taylor GI. The delay phenomena: the story unfolds. Plast Reconstr Surg. 1999;104:2079–91.

    Article  PubMed  CAS  Google Scholar 

  18. Freeman BS. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast Reconstr Surg. 1962;30:676–82.

    Article  CAS  Google Scholar 

  19. Palmieri B, Baitchev G, Grappolini S, Costa A, Benuzzi G. Delayed nipple-sparing modified subcutaneous mastectomy: Rationale and technique. Breast J. 2005;11:173–8.

    Article  PubMed  Google Scholar 

  20. Spear SL, Hannan CM, Wiley SC, Cocilovo C. Nipple sparing mastectomy. Plast Reconstr Surg. 2009;123:1665–73.

    Article  PubMed  CAS  Google Scholar 

  21. Jensen JA. Nipple-sparing mastectomy: what is the best evidence for safety? Plast Reconstr Surg. 2009;124:2195–7.

    Article  PubMed  CAS  Google Scholar 

  22. Spear SL, Rottman SJ, Seiboth LA, Hannan CM. Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction. Plast Reconstr Surg. 2012;129:572–81.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Geffen School of Medicine at U.C.L.A., Los Angeles, CA, USA

    J. Arthur Jensen MD

  2. Division of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    J. Arthur Jensen MD, Jennifer H. Lin MD, Nimmi Kapoor MD & Armando E. Giuliano MD

  3. Division of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Nimmi Kapoor MD

  4. Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Armando E. Giuliano MD

Authors
  1. J. Arthur Jensen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer H. Lin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nimmi Kapoor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Armando E. Giuliano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Arthur Jensen MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jensen, J.A., Lin, J.H., Kapoor, N. et al. Surgical Delay of the Nipple–Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy. Ann Surg Oncol 19, 3171–3176 (2012). https://doi.org/10.1245/s10434-012-2528-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2528-7

Keywords

Search

Navigation