When mastectomy becomes inevitable: The nipple-sparing approach

Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20 141 Milan, Italy.
The Breast (Impact Factor: 2.58). 01/2006; 14(6):527-31. DOI: 10.1016/j.breast.2005.08.028
Source: PubMed

ABSTRACT The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.

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    ABSTRACT: Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.
    06/2011; 2011:980158. DOI:10.1155/2011/980158
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    ABSTRACT: Background: Nipple sparing mastectomy (NSM) can be performed for prophylactic mastectomy and the treatment of selected breast cancer with oncologic safety. The risk of skin and nipple necrosis is a frequent complication of NSM procedure, and it is usually related to surgical technique. However, the role of the breast morphology should be also investigated. Method: We prospectively performed an analysis of 124 NSM from September 2012 to January 2013 at the European Institute of Oncology, Milan, Italy, focusing on necrotic complications. We analyzed the association between the risks of skin necrosis and the breast morphology of the patients. Results: Among 124 NSM in 113 patients, NSM procedures were associated with necrosis in 22 mastectomies (17.7%) among which included partial necrosis of nipple-areolar complex (NAC) in 15 of 124 NSM (12.1%) and total necrosis in 4 cases (3.5%). The NAC was removed in 5 NSM cases (4%). The volume of breast removed was the only significant factor increasing the risk of skin necrosis. The degree of ptosis was not significantly related to the necrosis risk. Conclusions: Large glandular specimen increases the risk of NAC necrosis. The degree of ptosis and the distance between the sternal notch and the NAC have no significant impact on necrotic complications in NSM. To reduce the necrotic complications in large breast after NSM, reconstruction should better be performed with autologous flap or slow skin expansion using the expander technique.
    01/2014; 2(1):e99. DOI:10.1097/GOX.0000000000000038
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    ABSTRACT: BACKGROUND: Nipple-sparing mastectomy (NSM) has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern remains regarding tumor recurrence. We report our experience performing NSM for breast cancer treatment and prophylaxis over a 6-year period. METHODS: A retrospective chart review on patients undergoing NSM or skin-sparing mastectomy (SSM) from 2005 to 2011 was performed. RESULTS: NSM patients were younger (P < .001), had a lower body mass index (P < .001), and were associated with a family cancer risk (P = .01) but not genetic risk (P = .83). There was no difference in the distance between the tumor and the nipple-areola complex when comparing NSM and SSM (P = .47). There was no significant difference in recurrence (P = .08) or survival (P = .38) when comparing NSM and SSM after controlling for age, stage, and surgery laterality. CONCLUSIONS: There was no difference in survival or cancer recurrence for NSM or SSM. NSM does not increase the risk of recurrence or decrease survival.
    The American Journal of Surgery 01/2014; 209(1). DOI:10.1016/j.amjsurg.2014.04.001 · 2.41 Impact Factor