Conservative mastectomy: Extending the idea of breast conservation

Scientific Direction, European Institute of Oncology, Milan, Italy.
The Lancet Oncology (Impact Factor: 24.69). 07/2012; 13(7):e311-7. DOI: 10.1016/S1470-2045(12)70133-X
Source: PubMed


Conservative mastectomy is a surgical technique to remove breast glandular tissue without disruption to the appearance of the breast. The main contraindication to this operation is involvement of the nipple-areola complex. Preservation of a healthy nipple does not affect long-term survival rates. Intraoperative retroareolar biopsy and accurate removal of all mammary tissue are mainstays to guarantee oncological safety of the technique. A complication, however infrequent, is nipple necrosis, which can be treated successfully by local excision. Several breast reconstructive techniques are used during conservative mastectomy and aesthetic results are good in most cases.

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    • "Nipple sparing mastectomy (NSM) is deemed as an extension of breast conservative surgery. The definition of " conservative mastectomy " might appear a contradiction in terms, but becomes appropriate when considering conservation as the maintenance of body image [3]. In 1951 Rice and Strickler realized for a benign disease the first mastectomy with preservation of skin and nipple areola complex (NAC) [4]. "
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    ABSTRACT: Background: Nipple sparing mastectomy is deemed surgically and oncologically safe based on a long lasting literature data from reviews of single institution series. This study aims at evaluating surgical and oncological outcomes of NSM on a large multi-institutional scale, by means of the Italian National registry. Methods: In July 2011 a panel of Italian specialists agreed upon and designed a National database of NSM. Centers with at least 150 cancers per year and following the National follow-up schedule guidelines could participate inserting any NSM case performed, retrospectively and prospectively from that moment on. In March 2015 analysis of data was accomplished. Dataset for this study consists of cases performed in the period between January 1st 2009 and December 31st 2014. Results: 913 Women were included in the analysis, for a total of 1006 procedures. Prophylactic mastectomies were 124 (12.3%). MRI utilization increased over time. NSM failure rate, with NAC removal for any reason was 11.5%. NAC necrosis rate was 4.8%. Larger skin-flap necrosis rate was 2.3%. Major surgical complications rate was 4.4%. Oncological outcomes were calculated among primitive EBC cases only: locoregional recurrences rate was 2.9%, NAC recurrence 0.7%. Systemic recurrence rate was 1.0%. Five deaths (0.7%) were registered. Conclusions: More than 10% of NSM procedures are prophylactic mastectomies. MRI is gaining more importance over time. Surgical and oncological results show that NSM is effective. This National multicentric analysis enables a comparison of results with no geographical differences and a "safe" state of the art of NSM in Italy.
    Full-text · Article · Nov 2015 · The Breast
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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.
    No preview · Article · Jun 2013 · Current Breast Cancer Reports
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    ABSTRACT: Over time, surgical techniques have advanced to the point where oncological safety and aesthetic outcomes are the pillars of contemporary breast surgery. Variations of mastectomy came up and started allowing the oncological safety and the possibility of an immediate breast reconstruction. Nowadays the association between plastic surgical techniques and mastectomy with immediate breast reconstruction is one of the best alternatives to treat breast cancer and also improved overall aesthetic outcomes and favors the achievement of contralateral breast symmetry. "Oncoplastic mastectomy" is a feasible term and can be routinely used.
    No preview · Article · May 2013
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