Annals of Surgical Oncology

, Volume 20, Issue 10, pp 3218–3222 | Cite as

Increasing Eligibility for Nipple-Sparing Mastectomy

  • Suzanne B. Coopey
  • Rong Tang
  • Lan Lei
  • Phoebe E. Freer
  • Kari Kansal
  • Amy S. Colwell
  • Michele A. Gadd
  • Michelle C. Specht
  • William G. AustenJr.
  • Barbara L. Smith
Breast Oncology



Eligibility for nipple-sparing mastectomy (NSM) varies widely on the basis of patient and tumor factors.


Review of patients undergoing NSM from June 2007 to December 2012 at our institution was performed. Patient and tumor characteristics, complications, and recurrences were collected. NSM from 2007 to 2010 and 2011 to 2012 were compared to assess trends in eligibility and outcomes over time.


NSM was performed on 645 breasts in 370 patients. Indications were risk reduction in 330 (51.2 %), invasive cancer in 226 (35.0 %), and ductal carcinoma-in situ in 89 (13.8 %) breasts. Fifty-one (13.8 %) patients had positive lymph nodes. Twenty-seven (7.3 %) patients received neoadjuvant chemotherapy. Forty-eight (7.4 %) breasts had prior radiotherapy. Total nipple necrosis occurred in 11 (1.7 %) breasts. Twenty-four (3.7 %) breasts had nipples removed as a result of positive subareolar/nipple margins. At 22 months’ mean follow-up, local recurrence occurred in 4 of 156 (2.6 %) breasts operated on for cancer through 2011. No recurrences involved the nipple. NSM performed in 2011–2012 (n = 475) compared to 2007–2010 (n = 170), were more often for cancer, in patients with higher body mass index, and on larger breasts (p < 0.001). There was no significant difference in total nipple necrosis rates between groups. Nipple loss due to positive subareolar/nipple margins was significantly less in 2011–2012 (p = 0.027).


Eligibility for NSM has expanded to include women with higher body mass index and larger breasts, with no increase in nipple loss due to ischemia. Rates of positive subareolar margins have decreased over time, even though NSM is being performed more frequently for cancer, suggesting improved patient selection.


Inflammatory Breast Cancer Nipple Breast Magnetic Resonance Imaging Inframammary Fold Ptotic Breast 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Suzanne B. Coopey
    • 1
  • Rong Tang
    • 1
  • Lan Lei
    • 1
  • Phoebe E. Freer
    • 2
  • Kari Kansal
    • 1
  • Amy S. Colwell
    • 3
  • Michele A. Gadd
    • 1
  • Michelle C. Specht
    • 1
  • William G. AustenJr.
    • 3
  • Barbara L. Smith
    • 1
  1. 1.Division of Surgical OncologyMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyMassachusetts General HospitalBostonUSA
  3. 3.Division of Plastic and Reconstructive SurgeryMassachusetts General HospitalBostonUSA

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