When mastectomy becomes inevitable: the nipple-sparing approach.
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.
- Breast Diseases A Year Book Quarterly 01/2008; 18(4):370-371.
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ABSTRACT: Tailored therapy for breast cancer with conservation of uninvolved tissue is becoming increasingly important, especially as the benefits of breast reconstruction are recognized. Preservation of the nipple areolar complex during mastectomy is emerging as a viable option in selected patients. Technical considerations for prevention of adverse outcomes such as nipple necrosis are reviewed, along with implications for reconstructive method and outcomes. Finally, the oncologic efficacy of nipple-sparing mastectomy is discussed in the context of occult nipple disease and local recurrence. Standardization of technique, optimization of aesthetic outcome, and examination of long-term prognosis represent future areas of development.Current Breast Cancer Reports 5(2).
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ABSTRACT: We report our senior author's experience with nipple-areolar complex (NAC) malposition following nipple sparing mastectomy (NSM), surgical options for treatment, and an analysis of risk factors. A retrospective review was conducted on a prospectively-collected IRB-approved database of NSM cases with immediate device-based reconstruction performed between July 2006 and October 2012. Malposition was graded as mild displacement (1cm), moderate (2cm), or severe (>3cm). 319 NSMs were reviewed. Malposition occurred in 13.79% (n=44). Significant factors were age (p<0.0001), diabetes mellitus (p=0.0025), body mass index (p=0.0093), preoperative sternal notch to nipple distance (p=0.015), preoperative breast base width (p=0.0001), peri-areolar mastectomy incision with lateral extension (p <0.0001), prior radiation therapy (p=0.0004), prior ipsilateral lumpectomy (p=0.0125), unilateral NSM (p=0.0004), and postoperative NAC ischemia (p=0.0174). Smoking status, breast volume resected, implant size, ablative surgeon, acellular dermal matrix, and single-stage reconstruction were not significant.19/44 malposition cases were satisfied. 8/44 cases were not offered surgical correction because of an inadequate skin envelope. 8/44 cases had crescent mastopexy, 3/44 had implant exchange and pocket revision, 4/44 had free nipple grafts, and 2/44 had pedicled nipple transposition. 2/44 had nipple excision and reconstruction secondary to recurrence. There were no incidences of necrosis or malposition after surgical correction. NSM followed by immediate device-based reconstruction has an identifiable risk of nipple malposition. We found several risk factors to be significantly associated with nipple malposition. Various surgical procedures are available to correct nipple malposition based on clinical presentation and are safe in a well-selected population.Level of Evidence: II / III.Plastic and reconstructive surgery 01/2014; · 2.74 Impact Factor