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Tumor Involvement of the Nipple in Total Skin-Sparing Mastectomy: Strategies for Management

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

Abstract

Background

Despite a growing body of literature on oncologic and reconstructive outcomes after total skin-sparing mastectomy (TSSM), some questions related to this approach remain unanswered, including strategies for managing tumor involvement of the nipple while maintaining the aesthetic benefits of TSSM.

Methods

A prospectively maintained database of patients undergoing TSSM and immediate breast reconstruction from 2005 to 2013 was reviewed. Outcomes included tumor involvement of resected nipple tissue and subsequent management, recurrences after nipple involvement, and trends in management of involved nipple tissue.

Results

The study included 1176 breasts in 751 patients treated with TSSM. The follow-up period was 31.3 months. The nipple–areolar complex (NAC) of 32 breasts (2.7 %) had a positive margin or involvement of nipple tissue. Of these breasts, 56 % contained invasive cancer, and 44 % had in situ disease. Management included repeat excision (11 cases, 34 % of cases), radiation of the NAC (as part of the postmastectomy breast field) without further excision (5 cases, 16 %), complete NAC removal (8 cases, 25 %), and no further treatment (8 cases, 25 %). Management by complete NAC skin excision significantly decreased during the study period (p = 0.003). The overall local recurrence rate was 6.2 %. No patients had recurrence in the preserved NAC skin.

Conclusions

Despite expanding indications for TSSM, it can be performed safely with low rates of nipple involvement. Over time, tumor involvement of the nipple has been treated with re-excision or other alternative approaches to NAC removal that preserve the aesthetic benefits of total skin-sparing approaches without an early adverse impact on local recurrence.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA

    Dominic Amara BA, Anne Warren Peled MD, Cheryl A. Ewing MD, Michael Alvarado MD & Laura J. Esserman MBA

  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Anne Warren Peled MD & Frederick Wang MD

Authors
  1. Dominic Amara BA
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  2. Anne Warren Peled MD
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  3. Frederick Wang MD
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  4. Cheryl A. Ewing MD
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  5. Michael Alvarado MD
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  6. Laura J. Esserman MBA
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Corresponding author

Correspondence to Laura J. Esserman MBA.

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Amara, D., Peled, A.W., Wang, F. et al. Tumor Involvement of the Nipple in Total Skin-Sparing Mastectomy: Strategies for Management. Ann Surg Oncol 22, 3803–3808 (2015). https://doi.org/10.1245/s10434-015-4646-5

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  • DOI: https://doi.org/10.1245/s10434-015-4646-5

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