Annals of Surgical Oncology

, Volume 6, Issue 6, pp 609–613 | Cite as

The Incidence of Occult Nipple-Areola Complex Involvement in Breast Cancer Patients Receiving a Skin-Sparing Mastectomy

  • Christine Laronga
  • Bonnie Kemp
  • Dennis Johnston
  • Geoffrey L. Robb
  • S. Eva Singletary
Original Article


Background: Surgical treatment of breast cancer traditionally has included resection of the nipple-areola complex (NAC), in the belief that this area had a significant probability of containing occult tumors. The purpose of this study was to investigate the true incidence of NAC involvement in patients who underwent a skin-sparing mastectomy (SSM) and to determine associated risk factors.

Methods: A retrospective chart review was conducted of 326 patients who had a SSM at our institution from 1990 to 1993. NAC involvement was reviewed in 286 mastectomy specimens. The charts were analyzed for tumor size, site, histology, grade, nodal status, recurrence, survival, and NAC involvement.

Results: Occult tumor involvement in the NAC was found in 5.6% of mastectomy specimens (16 patients). Four patients would have had NAC involvement identified on frozen section if they had been undergoing a skin-sparing mastectomy with preservation of the NAC. There were no significant differences between NAC-positive (NAC+) and NAC-negative (NAC-) patients in median tumor size, nuclear grade, histologic subtype of the primary tumor, or receptor status. There were significant differences in location of the primary tumor (subareolar or multicentric vs. peripheral) and positive axillary lymph node status. NAC involvement was not a marker for increased recurrence or decreased survival.

Conclusions: Occult NAC involvement occurred in only a small percentage of patients undergoing skin-sparing mastectomies. NAC preservation would be appropriate in axillary node-negative patients with small, solitary tumors located on the periphery of the breast.

Key Words

Occult nipple involvement Skin-sparing mastectomy 


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Copyright information

© The Society of Surgical Oncology, Inc. 1999

Authors and Affiliations

  • Christine Laronga
    • 1
  • Bonnie Kemp
    • 2
  • Dennis Johnston
    • 3
  • Geoffrey L. Robb
    • 4
  • S. Eva Singletary
    • 1
    • 5
  1. 1.Department of Surgical OncologyThe University of Texas M.D. Anderson Cancer CenterHouston
  2. 2.Department of PathologyThe University of Texas M.D. Anderson Cancer CenterHouston
  3. 3.Department of BiomathematicsThe University of Texas M.D. Anderson Cancer CenterHouston
  4. 4.Department of Plastic SurgeryThe University of Texas M.D. Anderson Cancer CenterHouston
  5. 5.Dept. of Surgical OncologyThe University of Texas M.D. Anderson Cancer CenterHouston

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