Evolution and time trends of nipple-sparing mastectomy: a single-center experience


Nipple Sparing Mastectomy (NSM) requires the entire breast tissue to be removed, maintaining the nipple-areola complex, and represents nowadays the gold standard of the demolitive breast surgery. Although it represents the evolution of conservative breast surgery, NSM presents some limitations in the selection of women candidates for treatment, and still there are no real guidelines regarding its indications, but simply objective data to address the choice. How the breast surgery approach to demolitive and conservative surgery has changed over time? We evaluated throughout the years (from 2009 up to 2018) the time trend of NSM at our institution and analysed the main differences between patients undergone NSM and other mastectomies and/or breast conserving surgery in terms of cancer size, multicentricity and biological profile. We found 781 NSMs, 1261 other mastectomies and 5621 breast conservative surgeries. Among NSMs, 39.6% were reconstructed with tissue expander and 58.1% with definitive prosthesis. From 2009 to 2018 we found a general increase of NSM rate (from 21.3% of all mastectomies in 2009 to 67.3% in 2018) and a decrease of total mastectomies (from 78.7% of all mastectomies in 2009 to 32.7% in 2018). In line with the literature data, our data confirm that in the recent years NSM represents the gold standard for radical breast surgery. Undisputed in prophylaxis, NSM is continuously acquiring more support in being used as first line treatment for locally advanced disease.

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Fig. 1
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Nipple Sparing Mastectomy


Nipple-Areola Complex


Breast-Conserving Surgery


Pathologic Complete Response


  1. 1.

    Amabile MI, Monti M, Merola R, Frusone F, D'Orazi V, Pasta V (2016) Nipple-sparing mastectomy in patients with preoperative diagnosis of non-invasive breast carcinoma. A Single-center Experience Anticancer Res 36(2):779–783

    CAS  PubMed  Google Scholar 

  2. 2.

    Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC, Veronesi P, Petit J, Arnone P, Bassi F, Disa JJ, Garcia-Etienne CA, Borgen PI (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem. J Am Coll Surg 203(5):704–714. https://doi.org/10.1016/j.jamcollsurg.2006.07.015

    PubMed  Article  Google Scholar 

  3. 3.

    Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, Veronesi P (2017) Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast 34(Suppl 1):S82–S84. https://doi.org/10.1016/j.breast.2017.06.034

    PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Fortunato L, Loreti A, Andrich R, Costarelli L, Amini M, Farina M, Santini E, Vitelli CE (2013) When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications. J Surg Oncol 108(4):207–212. https://doi.org/10.1002/jso.23390

    PubMed  Article  Google Scholar 

  5. 5.

    Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 87(6):1048–1053

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) 20-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232. https://doi.org/10.1056/NEJMoa020989

    PubMed  Article  Google Scholar 

  7. 7.

    Suarez-Zamora DA, Barrera-Herrera LE, Palau-Lazaro MA, Torres-Franco F, Orozco-Plazas A, Barreto-Hauzeur L, Rodriguez-Urrego PA (2017) Accuracy and interobserver agreement of retroareolar frozen sections in nipple-sparing mastectomies. Ann Diagn Pathol 29:46–51. https://doi.org/10.1016/j.anndiagpath.2017.05.001

    PubMed  Article  Google Scholar 

  8. 8.

    Pasta V, D'Orazi V, Merola R, Frusone F, Amabile MI, De Luca A, Buè R, Monti M (2016) Oncoplastic central quadrantectomies. Gland Surg 5(4):422–426. https://doi.org/10.21037/gs.2016.04.01

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Smith BL, Tang R, Rai U, Plichta JK, Colwell AS, Gadd MA, Specht MC, Austen WG, Coopey SB (2017) Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg 225(3):361–365. https://doi.org/10.1016/j.jamcollsurg.2017.06.013

    PubMed  Article  Google Scholar 

  10. 10.

    Headon HL, Kasem A, Mokbel K (2016) The oncological safety of nipple-sparing mastectomy: a systematic review of the literature with a pooled analysis of 12,358 procedures. Arch Plast Surg 43(4):328–338. https://doi.org/10.5999/aps.2016.43.4.328

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    De La Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM (2015) Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol 22(10):3241–3249. https://doi.org/10.1245/s10434-015-4739-1

    Article  Google Scholar 

  12. 12.

    Agarwal S, Agarwal S, Neumayer L, Agarwal JP (2014) Therapeutic nipple-sparing mastectomy: trends based on a national cancer database. Am J Surg 208(1):93–98. https://doi.org/10.1016/j.amjsurg.2013.09.030

    PubMed  Article  Google Scholar 

  13. 13.

    Pasta V, Mitri F, Amabile MI, Picardi N (2006) Inflammatory breast cancer. Ann Ital Chir 77(3):275–279

    PubMed  Google Scholar 

  14. 14.

    Weber WP, Haug M, Kurzeder C, Bjelic-Radisic V, Koller R, Reitsamer R, Fitzal F, Biazus J, Brenelli F, Urban C et al (2018) Oncoplastic breast consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat 172(3):523–537. https://doi.org/10.1007/s10549-018-4937-1

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Palmieri A, D'Orazi V, Martino G, Frusone F, Crocetti D, Amabile MI, Monti M (2016) Plasma cell mastitis in men: a single-center experience and review of the literature. In Vivo 30(6):727–732. https://doi.org/10.21873/invivo.10987

    PubMed  Article  Google Scholar 

  16. 16.

    National Comprehensive Cancer Network (NCCN) (2019) Guidelines for breast cancer. https://www.nccn.org/professionals/physician_gls/default.aspx#site. Accessed 1 Mar 2019

  17. 17.

    Zhang H, Li Y, Moran MS, Haffty BG, Yang Q (2015) Predictive factors of nipple involvement in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 151(2):239–249. https://doi.org/10.1007/s10549-015-3385-4

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Smith BL, Coopey SB (2018) Nipple-sparing mastectomy. Adv Surg 52(1):113–126. https://doi.org/10.1016/j.yasu.2018.03.008

    PubMed  Article  Google Scholar 

  19. 19.

    Peled AW, Sbitany H, Foster RD, Esserman LJ (2014) Oncoplastic mammoplasty as a strategy for reducing reconstructive complications associated with postmastectomy radiation therapy. Breast J 20(3):302–307. https://doi.org/10.1111/tbj.12257

    PubMed  Article  Google Scholar 

  20. 20.

    Agresti R, Sandri M, Gennaro M, Bianchi G, Maugeri I, Rampa M, Capri G, Carcangiu ML, Trecate G, Riggio E, Lozza L, de Braud F (2017) Evaluation of local oncologic safety in nipple-areola complex-sparing mastectomy after primary chemotherapy: a propensity score-matched study. Clin Breast Cancer 17(3):219–231. https://doi.org/10.1016/j.clbc.2016.12.003

    PubMed  Article  Google Scholar 

  21. 21.

    Amara D, Peled AW, Wang F, Ewing CA, Alvarado M, Esserman LJ (2015) Tumor involvement of the nipple in total skin-sparing mastectomy: strategies for management. Ann Surg Oncol 22(12):3803–3808. https://doi.org/10.1245/s10434-015-4646-5

    PubMed  Article  Google Scholar 

  22. 22.

    Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, Bedolis R, Rietjens M, Garusi C, De Lorenzi F, Bosco R, Manconi A, Ivaldi GB, Youssef O (2009) Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a 5-year experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 117(2):333–338. https://doi.org/10.1007/s10549-008-0304-y

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    D'Egidio V, Sestili C, Mancino M, Sciarra I, Cocchiara R, Backhaus I, Mannocci A, De Luca A, Frusone F, Monti M, La Torre G, Di Murro F, Palmeri V, Lia L, Paradiso G, Aceti V, Libia A (2017) Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Qual Life Res 26(10):2573–2592. https://doi.org/10.1007/s11136-017-1613-6

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS (2018) Fertility preservation in women with gynaecologic cancer: the impact on quality of life and psychological well-being. Hum Fertil (Camb) 21(1):35–38. https://doi.org/10.1080/14647273.2017.1339365

    Article  Google Scholar 

  25. 25.

    Laganà AS, La Rosa VL, Rapisarda AM, Platania A, Vitale SG (2017) Psychological impact of fertility preservation techniques in women with gynaecological cancer. Ecancermedicalscience. https://doi.org/10.3332/ecancer.2017.ed62

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Słowik AJ, Jabłoński MJ, Michałowska-Kaczmarczyk AM, Jach R (2017) Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. Psychiatr Pol 51(5):871–888. https://doi.org/10.12740/PP/OnlineFirst/63787

    PubMed  Article  Google Scholar 

  27. 27.

    Vitale SG, Capriglione S, Zito G, Lopez S, Gulino FA, Di Guardo F, Vitagliano A, Noventa M, La Rosa VL, Sapia F et al (2019) Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet 299(2):299–315. https://doi.org/10.1007/s00404-018-5006-z

    PubMed  Article  Google Scholar 

  28. 28.

    Varghese F, Wong J (2018) Breast cancer in the elderly. Surg Clin North Am 98(4):819–833. https://doi.org/10.1016/j.suc.2018.04.002

    PubMed  Article  Google Scholar 

  29. 29.

    Regolo L, Ballardini B, Gallarotti E, Scoccia E, Zanini V (2008) Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast 17(1):8–11. https://doi.org/10.1016/j.breast.2007.07.040

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Chung AP, Sacchini V (2008) Nipple-sparing mastectomy: where are we now? Surg Oncol 17(4):261–266

    PubMed  Article  Google Scholar 

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Correspondence to Federico Frusone.

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Barbieri, E., Frusone, F., Bottini, A. et al. Evolution and time trends of nipple-sparing mastectomy: a single-center experience. Updates Surg 72, 893–899 (2020). https://doi.org/10.1007/s13304-020-00796-5

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  • Nipple Sparing Mastectomy
  • Mastectomy
  • Breast cancer
  • Breast surgery