Annals of Surgical Oncology

, Volume 15, Issue 12, pp 3396–3401 | Cite as

Nipple-Sparing Mastectomy: Critical Assessment of 51 Procedures and Implications for Selection Criteria

  • Anna M. Voltura
  • Theodore N. Tsangaris
  • Gedge D. Rosson
  • Lisa K. Jacobs
  • Jaime I. Flores
  • Navin K. Singh
  • Pedram Argani
  • Charles M. Balch
Breast Oncology



Retrospective studies have shown that occult nipple–areolar complex (NAC) involvement in breast cancer is low, occurring in 6–10% of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-sparing mastectomy (NSM) has prompted further evaluation of the oncologic safety of this procedure.


We conducted a retrospective chart review of 36 self-selected patients who underwent 51 NSM procedures between 2002 and 2007. Criterion for patient selection was no clinical evidence of nipple–areolar tumor involvement. All patients had the base of the NAC evaluated for occult tumor by permanent histologic section assessment. We also evaluated tumor size, location, axillary node status, recurrence rate, and cosmetic result.


Malignant NAC involvement was found in 2 of 34 NSM (5.9%) completed for cancer which prompted subsequent removal of the NAC. Of the 51 NSM, 17 were for prophylaxis, 10 for ductal carcinoma in situ (DCIS), and 24 for invasive cancer. The average tumor size was 2.8 cm for invasive cancer and 2.5 cm for DCIS. Nine patients had positive axillary nodes. Overall, 94% of the tumors were located peripherally in the breast. After mean follow-up of 18 months, only two patients (5.9%) had local recurrence.


Using careful patient selection and careful pathological evaluation of the subareolar breast tissue at surgery, NSM can be an oncologically safe procedure in patients where this is important to their quality of life. A prospective study based on focused selection criteria and long-term follow-up is currently in progress.


  1. 1.
    Rowland JH, Desmond KA, et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 2000; 17:1422–9CrossRefGoogle Scholar
  2. 2.
    Pelusi J. Sexuality and body image. AJN 2006; 106:32–8PubMedGoogle Scholar
  3. 3.
    Wilmoth MC. The after math of breast cancer: an altered sexual self. Cancer Nurs 2001; 24:278–86PubMedCrossRefGoogle Scholar
  4. 4.
    Cocquyt VF, Blondeel PN, Depypere HT, et al. Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 2003; 56:462–70PubMedCrossRefGoogle Scholar
  5. 5.
    Jabor MA, Shayani P, et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002; 110:457–63PubMedCrossRefGoogle Scholar
  6. 6.
    Newman LA, Kuerer HM, Hunt KK, et al. Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 1998; 5:620–6PubMedCrossRefGoogle Scholar
  7. 7.
    Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 1999:6:676–81PubMedCrossRefGoogle Scholar
  8. 8.
    Carlson GW, Styblo TM, et al. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol 2003; 10:108–12PubMedCrossRefGoogle Scholar
  9. 9.
    Ho CM, Mak CKL, Lau Y, et al. Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy. Ann Surg Oncol 2003;10:102–7PubMedCrossRefGoogle Scholar
  10. 10.
    Cunnick GH, Mokbel K. Skin-sparing mastectomy, review. Am J Surg 2004;188:78–84PubMedCrossRefGoogle Scholar
  11. 11.
    Laronga C, Kemp B, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999;6:609–13PubMedCrossRefGoogle Scholar
  12. 12.
    Fisher B, Bauer M, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665–73PubMedGoogle Scholar
  13. 13.
    Fisher B, Anderson S, et al. Twenty year follow-up of a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 2002;347:1233–41PubMedCrossRefGoogle Scholar
  14. 14.
    Gerber B, Krause A, et al. Skin-sparing mastectomy with conservation of the nippl-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 2003;238:120–7PubMedCrossRefGoogle Scholar
  15. 15.
    Crowe JP, Kim JA, et al. Nipple-sparing mastectomy, technique and results of 54 procedures. Arch Surg 2004;139:148–50PubMedCrossRefGoogle Scholar
  16. 16.
    Petit JY, Veronesi U, et al. When mastectomy becomes inevitable: the nipple-sparing approach. Breast 2005;14:527–31PubMedCrossRefGoogle Scholar
  17. 17.
    Caruso F, Ferrara M, et al. Nipple-sparing mastectomy: sixty-six months follow-up. EJSO 2006;32:937–40PubMedCrossRefGoogle Scholar
  18. 18.
    Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. EJSO 2008;34(2):143–8PubMedGoogle Scholar
  19. 19.
    Kennedy MJ, Abeloff MD. Management of locally recurrent breast cancer. Cancer 1993;71:2395–409PubMedCrossRefGoogle Scholar
  20. 20.
    Stolier AJ, Wang J. Terminal duct lobular units are scarce in the nipple: Implications for prophylactic nipple-sparing mastectomy. Ann Surg Oncol 2008;15(2):438–42PubMedCrossRefGoogle Scholar
  21. 21.
    Fisher E, Gregorio RM, Fisher B, et al. The pathology of invasive breast cancer. Cancer 1975;36:1–85PubMedCrossRefGoogle Scholar
  22. 22.
    Rusby JE, Brachtel EF, Taghian A, et al. Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg 2007;194(4):433–7PubMedCrossRefGoogle Scholar
  23. 23.
    Lambert PA, Kolm P, Perry RR. Parameters that predict nipple involvement in breast cancer. J Am Coll Surg 2000;191:354–9PubMedCrossRefGoogle Scholar
  24. 24.
    Andersen JA, Pallesen RM. Spread to the nipple and areola in carcinoma of the breast. Ann Surg 1979;189(3):367–72PubMedCrossRefGoogle Scholar
  25. 25.
    Lagios MD, Gates EA, et al. A guide to the frequency of nipple involvement in breast cancer. Am J Surg 1979;138:135–42PubMedCrossRefGoogle Scholar
  26. 26.
    Santini D, Taffurelli M, et al. Neoplastic involvement of nipple-areolar complex in invasive breast cancer. Am J Surg 1989;158:399–403PubMedCrossRefGoogle Scholar
  27. 27.
    Vlajcic Z, Zic R, Stanec S, et al. Nipple–areola complex preservation, predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 2005;55:240–4PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Anna M. Voltura
    • 1
  • Theodore N. Tsangaris
    • 1
  • Gedge D. Rosson
    • 2
  • Lisa K. Jacobs
    • 1
  • Jaime I. Flores
    • 2
  • Navin K. Singh
    • 2
  • Pedram Argani
    • 3
  • Charles M. Balch
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Division of Plastic Surgery, Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Pathology and OncologyJohns Hopkins UniversityBaltimoreUSA

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