Skip to main content
SpringerLink
Log in

Nipple and Areola-Sparing Mastectomy

  • Chapter
  • First Online:
Breast Surgical Techniques and Interdisciplinary Management

  • 2545 Accesses

Abstract

The success of skin-sparing mastectomies over the past two decades has led to a renewed interest in nipple and areola-sparing mastectomies in selected patients. Renewed interest lies in a desire for improved cosmetic and functional outcomes in the post-mastectomy patient. However, there is no consensus on selection criteria or technique and it remains a controversial issue among breast surgeons. A mastectomy preserving the nipple–areola complex (NAC) was first described by Freeman, who in 1962 advocated the procedure for benign lesions. The procedure was abandoned, however, amid concerns about complications and oncologic safety. Those concerns linger as there is no way to preserve the NAC without leaving ductal and parenchymal tissue behind. Our group is one of few which has looked at the malignant potential of the nipple and the areola separately. We have found that the risk of cancer, either occult or recurrent, is much lower in the areola. Therefore, to reduce the risk of missing occult or recurrent cancer in the nipple ducts, we recommend only the areola-sparing mastectomy (ASM) in carefully selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Suggested Reading

  1. •Crowe Jr JP, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg. 2004;139(2):148–50.

    Article  PubMed  Google Scholar 

  2. •Freeman BS. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast Reconstr Surg. 1962;30:676–82.

    Article  CAS  Google Scholar 

  3. •Freeman BS, Wiemer DS. Total glandular mastectomy. Modifications of the subcutaneous mastectomy for use in premalignant disease of the breast. Plast Reconstr Surg. 1978;62(2):167–72.

    Article  PubMed  CAS  Google Scholar 

  4. •Garcia-Etienne CA, Borgen PI. Update on the indications for nipple-sparing mastectomy. J Support Oncol. 2006;4(5):225–30.

    PubMed  Google Scholar 

  5. •Gerber B, Krause A, Reimer T, Müller H, Küchenmeister I, Makovitzky J, et al. Skin–sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238(1):120–7.

    PubMed  Google Scholar 

  6. •Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340(2):77–84.

    Article  PubMed  CAS  Google Scholar 

  7. •Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol. 1998;5(3):220–6.

    Article  PubMed  CAS  Google Scholar 

  8. •Petit JY, Veronesi U, Orecchia R, Luini A, Rey P, Intra M, et al. Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat. 2006;96(1):47–51.

    Article  PubMed  Google Scholar 

  9. •Rusby JE, Brachtel EF, Michaelson JS, Koerner FC, Smith BL. Breast duct anatomy in the human nipple: three-dimensional patterns and clinical implications. Breast Cancer Res Treat. 2007;106:171–9.

    Article  PubMed  Google Scholar 

  10. •Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203(5):704–14.

    Article  PubMed  Google Scholar 

  11. •Schnitt SJ, Goldwyn RM, Slavin SA. Mammary ducts in the areola: implications for patients undergoing reconstructive surgery of the breast. Plast Reconstr Surg. 1993;92(7):1290–3.

    PubMed  CAS  Google Scholar 

  12. •Simmons RM, Brennan M, Christos P, King V, Osborne M. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol. 2002;9(2):165–8.

    Article  PubMed  Google Scholar 

  13. •Simmons RM, Hollenbeck ST, Latrenta GS. Areola-sparing mastectomy with immediate breast reconstruction. Ann Plast Surg. 2003;51(6):547–51.

    Article  PubMed  Google Scholar 

  14. •Simmons RM, Hollenbeck ST, Latrenta GS. Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg. 2004;188(4):403–6.

    Article  PubMed  Google Scholar 

  15. •Smith DM, Peters TG, Donegan WL. Montgomery’s areolar tubercle. A light microscopic study. Arch Pathol Lab Med. 1982;106(2):60–3.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Hospital Weill Cornell Medical Center, Weill Cornell Medical College, New York, NY, USA

    Rache M. Simmons

Authors
  1. Meredith Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rache M. Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rache M. Simmons .

Editor information

Editors and Affiliations

  1. Middle Ave. 1285, Menlo Park, 94025, California, USA

    Frederick Dirbas

  2. Iowa City, USA

    Carol Scott-Conner

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer New York

About this chapter

Cite this chapter

Kato, M., Simmons, R.M. (2010). Nipple and Areola-Sparing Mastectomy. In: Dirbas, F., Scott-Conner, C. (eds) Breast Surgical Techniques and Interdisciplinary Management. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6076-4_36

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-6076-4_36

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-6075-7

  • Online ISBN: 978-1-4419-6076-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation