Update on the indications for nipple-sparing mastectomy. Memorial Sloan-Kettering Cancer Center

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
The journal of supportive oncology 06/2006; 4(5):225-30.
Source: PubMed


There is renewed interest in the use of nipple-sparing mastectomy (NSM), which combines skin-sparing mastectomy with preservation of the nipple-areola complex. NSM may be an oncologically safe treatment in a subgroup of patients who are candidates for breast-conserving surgery but still prefer to undergo mastectomy. A combination of newer techniques and good coordination between plastic and oncologic surgeons can achieve excellent cosmetic results and a low incidence of postoperative complications. However, major concerns about NSM include the persistent risk for breast cancer development when it is used for prophylaxis as well as the potential failure of local control when it is used for treatment. The reported experience with these newer techniques lacks the power to generate a consensus for its indications because of limited reported series with small populations. Although the current role of NSM seems to be more defined as a prophylactic procedure in high-risk patients, prospective studies and reports are needed to better define its indications.

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    • "Several studies such as those by Pennisi and Capozzi [2] and by Woods [3] have been conducted, where only few patients, from more than 1,000 patients included in the study (prophylactic subcutaneous mastectomy), developed breast cancer after years of follow-up (incidence rate 0.6%). However, one of the major concerns about nipple sparing mastectomy is the persistent risk of breast cancer development when this is used for prophylaxis, with much controversy about the safety of these procedures from an oncological point of view [4,5]. At present there are no randomized studies on the effects of long-term testosterone use on breast cancer risk. "
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    ABSTRACT: The incidence of breast carcinoma following prophylactic mastectomy is probably less than 2%. We present a 43-year-old female to male transsexual who developed breast cancer 1 year after bilateral nipple- sparing subcutaneous mastectomy as part of female to male gender reassignment surgery. In addition to gender reassignment surgery, total abdominal hysterectomy with bilateral salpingo-oophorectomy (to avoid the patient from entering menopause and to eliminate any subsequent risk of iatrogenic endometrial carcinoma), colpocleisys, metoidioplasty, phalloplasty, urethroplasty together with scrotoplasty/placement of testicular prosthesis and perineoplasty were also performed. Before the sex change surgery, the following diagnostic procedures were performed: breast ultrasound and mammography (which were normal), lung radiography (also normal) together with abdominal ultrasound examination, biochemical analysis of the blood and hormonal status. According to medical literature, in the last 50 years only three papers have been published with four cases of breast cancer in transsexual female to male patients. All hormonal pathways included in this complex hormonal and surgical procedure of transgender surgery have important implications for women undergoing prophylactic mastectomy because of a high risk of possible breast cancer.
    World Journal of Surgical Oncology 12/2012; 10(1):280. DOI:10.1186/1477-7819-10-280 · 1.41 Impact Factor
  • Breast Diseases A Year Book Quarterly 01/2009; 20(4):407–409. DOI:10.1016/S1043-321X(09)79444-5
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    ABSTRACT: As genetic testing to identify hereditary susceptibility for breast cancer becomes more widely available, interest in prophylactic mastectomy is becoming more popular. Patients with unilateral breast cancer are also pursuing prophylactic contralateral mastectomy for its risk-reducing and symmetry benefits. This review discusses the selection of candidates for prophylactic mastectomy, its benefits, and data on effectiveness of this surgery.
    Current Breast Cancer Reports 06/2013; 5(2). DOI:10.1007/s12609-013-0110-3
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