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The Vertical Infra-Areolar Approach to Nipple Skin-Sparing or Total Skin-Sparing Mastectomy

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Operative Approaches to Nipple-Sparing Mastectomy

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Abstract

The total skin-sparing mastectomy has become routinely offered to patients in our practice as the mastectomy has evolved from the radical, to modified radical, to simple mastectomy, then skin-sparing, and now total skin-sparing or nipple skin-sparing mastectomy. The current literature suggests that the total skin-sparing mastectomy is an oncologically safe procedure for patients, excluding those with involvement of the nipple-areola complex and those with skin involvement or inflammatory breast cancer. Throughout our experience with the total skin-sparing mastectomy, our techniques and inclusion criteria for the procedure have evolved as more data has become available.

We begin with our pre-incision injections for routine performance of the axillary reverse mapping procedure. This technique is used for sentinel lymph node biopsies as well as axillary lymph node dissections to minimize lymphedema of the ipsilateral upper extremity. Although our initial experience with the total skin-sparing mastectomy was mostly via an inframammary incision, we have transitioned to the vertical infra-areolar approach to the nipple-sparing mastectomy in most cases. This incision provides maximal preservation of the blood supply to the nipple and creates a superior cosmetic outcome to most other incisions as it sets the nipples in correct and matching position. However, we do recognize that there are exceptions, and we do utilize various other incisions when necessary.

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Author information

Authors and Affiliations

  1. Department of Breast Surgical Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA

    Amy Rivere M.D.

  2. Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA

    Pallavi Archana Kumbla M.D.

  3. Department of Surgery and Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 725, Little Rock, AR, 72205, USA

    V. Suzanne Klimberg M.D., F.A.C.S.

Authors
  1. Amy Rivere M.D.
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  2. Pallavi Archana Kumbla M.D.
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  3. V. Suzanne Klimberg M.D., F.A.C.S.
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Corresponding author

Correspondence to V. Suzanne Klimberg M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Center for Cancer Prevention and TreatmentSt, Joseph Hospital, Orange, California, USA

    Jay K. Harness

  2. Professor of Clinical Surgery Director, MedStar Regional Breast Health Program, Vice-Chair, Department of Surgery MedStar Georgetown University Hospital, Washington, District of Columbia, USA

    Shawna C. Willey

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© 2017 Springer International Publishing Switzerland

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Rivere, A., Kumbla, P.A., Klimberg, V.S. (2017). The Vertical Infra-Areolar Approach to Nipple Skin-Sparing or Total Skin-Sparing Mastectomy. In: Harness, J., Willey, S. (eds) Operative Approaches to Nipple-Sparing Mastectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-43259-5_6

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  • DOI: https://doi.org/10.1007/978-3-319-43259-5_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43257-1

  • Online ISBN: 978-3-319-43259-5

  • eBook Packages: MedicineMedicine (R0)

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