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Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple–Areolar Complex

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

Abstract

Background

The aim of this study is to describe a less aggressive approach to management of positive nipple margin following nipple-sparing mastectomy (NSM), allowing for preservation of the nipple–areolar complex (NAC).

Study Design

A single-institution retrospective chart review was performed for patients undergoing NSM from 1989 to 2017. Positive nipple margin was defined as any residual invasive carcinoma or ductal carcinoma in situ (DCIS) within the additional nipple margin. Management included complete NAC removal, subareolar shave biopsy, or observation alone. Primary outcomes included rates of positive nipple margin and local recurrence.

Results

A total of 819 breasts underwent NSM, yielding a total of 32 breasts (3.9%) with positive nipple margin. Management included 11 (34.4%) subareolar shave biopsies, 15 (46.9%) complete NAC excisions, and 5 (15.6%) with observation alone, plus 1 (3.1%) lost to follow-up. Final pathology after subareolar shave biopsy did not reveal any residual disease, and no patients developed NAC necrosis or required NAC removal. Final pathology after NAC excision revealed 3 of 15 with additional disease (1 invasive ductal carcinoma, 2 DCIS). Of the five patients who had no subsequent intervention, tumor pathology was DCIS in all cases. One patient received adjuvant radiation therapy. Mean time to intervention was 3.7 ± 1.9 with mean follow-up of 2.9 years.

Conclusions

Management of positive nipple margin after NSM with subareolar shave biopsy is a safe alternative to preserve the NAC.

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Author information

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd., NW, PHC Building, 4th Floor, Washington, DC, 20007, USA

    Michelle L. Haslinger MD, Michael Sosin MD, Alex J. Bartholomew MS, Andrew Crocker MS, Aiste Gulla MD, Shawna C. Willey MD, FACS, Troy A. Pittman MD & Eleni A. Tousimis MD, FACS

Authors
  1. Michelle L. Haslinger MD
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  2. Michael Sosin MD
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  3. Alex J. Bartholomew MS
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  4. Andrew Crocker MS
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  5. Aiste Gulla MD
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  6. Shawna C. Willey MD, FACS
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  7. Troy A. Pittman MD
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  8. Eleni A. Tousimis MD, FACS
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Corresponding author

Correspondence to Eleni A. Tousimis MD, FACS.

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Haslinger, M.L., Sosin, M., Bartholomew, A.J. et al. Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple–Areolar Complex. Ann Surg Oncol 25, 2303–2307 (2018). https://doi.org/10.1245/s10434-018-6569-4

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  • DOI: https://doi.org/10.1245/s10434-018-6569-4

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