Nipple-sparing mastectomy: Where are we now?

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Surgical Oncology (Impact Factor: 2.37). 06/2008; 17(4):261-6. DOI: 10.1016/j.suronc.2008.03.004
Source: PubMed

ABSTRACT Surgical treatment of breast cancer has evolved from radical mastectomy with routine removal of the nipple-areolar complex (NAC) to breast conservative therapy with preservation of the breast and NAC. When breast conservation is not appropriate or the patient desires mastectomy for risk reduction, conventional therapy still consists of mastectomy with removal of the NAC, followed by reconstruction. Rising interest in improved cosmesis has led to the introduction of the skin-sparing and nipple-sparing mastectomy (NSM) as potential alternatives to mastectomy. There has been much controversy regarding the oncologic safety of these procedures, and the NSM has also introduced a set of complications, such as nipple and areolar necrosis, that are not a concern with total mastectomy. From our review of the literature, we feel that NSM may be a viable option in the appropriate setting, and that its risks and complications are acceptable when compared to the traditional surgical treatment of breast cancer.

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    ABSTRACT: The procedures used to diagnose, stage, and treat breast dis-ease are rapidly becoming less invasive and more cosmetically satisfying while remaining oncologically sound. In particular, percutaneous core biopsy has largely replaced excisional breast biopsy for both palpable and nonpalpable breast lesions and has proved to be an equally accurate, less invasive, and less costly means of pathologic diagnosis. 1 Moreover, in clin-ically appropriate patients, sentinel lymph node biopsy (SLNB) has proved to be an accurate method of staging the axilla that reduces the incidence of many of the complications associated with traditional axillary node dissection. 2 Further-more, breast conservation has largely supplanted mastectomy for defi nitive surgical treatment of breast cancer; randomized trials continue to demonstrate equivalent survival rates for the two therapies. 3 Even in those cases where mastectomy is either required or preferred, advances in reconstructive tech-niques have been made that yield signifi cantly improved out-comes after breast reconstruction. 4 Finally, in an effort to eliminate the need for open surgical treatment of breast cancer, various percutaneous extirpative and ablative local therapies have been developed and are being evaluated for potential use in managing breast cancer in carefully selected patients. 5 A more minimally invasive approach to breast disease will depend to a substantial extent on the availability of accurate and effi cient imaging modalities. Adeptness with such modal-ities is rapidly becoming an essential part of the general sur-geon's skill set. In this chapter, we describe selected standard, novel, and investigational procedures employed in the diagno-sis and management of breast disease. The application of these procedures is a dynamic process that is shaped both by tech-nological advances and by physicians' evolving understanding of the biology of breast diseases. Breast Ultrasonography Breast ultrasonography can be useful for evaluating palpable breast masses or mammographically indeterminate lesions; for carrying out postoperative and oncologic follow-up; for guid-ing aspiration and biopsy of lesions; and for facilitating intra-operative tumor localization, margin assessment, placement of catheters for partial-breast irradiation, and investigational tumor-ablating techniques. In the offi ce, breast ultrasonography has become a useful adjunct to the clinical breast examination, particularly in patients with radiographically dense mammograms. It defi nes breast lesions more clearly than physical examination does and thus can potentially reduce the number of unnecessary biop-sies done for simple cysts or fi broglandular tissue presenting as a palpable nodularity. Whole-breast ultrasonography is not an effective screening tool and therefore should not be a substitute for annual mammography. The American College of Surgeons (ACS) and various surgical subspecialty organi-zations offer a multitude of courses, at varying skill levels, geared toward training general surgeons in the use of breast ultrasonography.
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    ABSTRACT: Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and careful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.
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    ABSTRACT: Introduction Due to the fact that the number of breast implant surgeries for cosmetic and medical purposes is rising yearly, a discussion about the quality of service for both patients and physicians is more important than ever. To this end, we reviewed the Austrian Breast Implant Register with one specific question in mind: What are the trends? Materials and Methods In the statistical analysis of the Austrian Breast Implant Register, we were able to identify 13,112 registered breast implants between 2004 and 2012. The whole dataset was then divided into medical and cosmetic groups. We focused on device size, surface characteristics, filling material, device placement and incision site. All factors were considered for all examined years. Results In summary, the most used device had a textured surface (97 %) and silicone gel as the filling material (93 %). The mean size of implants for the cosmetic group was 240 cc, placement was submuscular (58 %) and the incision site was inframammary (67 %). In the medical group, the mean size was 250 cc. Yearly registrations had their peak in 2008 (1,898 registered devices); from this P. Wurzer (&) 􏰀 T. Rappl 􏰀 L.-P. Kamolz 􏰀 S. Spendel 􏰀 D. Parvizi Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria e-mail: H. Friedl Institute of Statistics, Graz University of Technology, Kopernikusgasse 24/III, 8010 Graz, Austria H. Hoflehner Schwarzl Clinic, Hauptstraße 140, 8301 Lassnitzho ̈he, Austria year on, registrations decreased annually. A slight trend away from subglandular placement in the cosmetic group was noted. Also, the usage of implants with polyurethane surface characteristics has increased since 2008. The smooth surface implants had a peak usage in 2006 and their usage decreased steadily from then on whereas the textured surface was steady over the years. Discussion and Conclusion Keeping the problems related to the quality of breast implants in mind, we could rec- ommend an obligatory national register. Organisations of surgeons and governments should develop and establish these registers. Furthermore, an all-encompassing interna- tional register should be established by the European Union and the American FDA (Food and Drug Administration); this might be useful in comparing the individual country registers and also would help in delivering ‘‘evidence based’’ medicine in cosmetic and medical procedures.
    Aesthetic Plastic Surgery 10/2014; DOI:10.1007/s00266-014-0407-2 · 1.19 Impact Factor