Nipple-sparing mastectomy: where are we now? Surg Oncol

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Surgical Oncology (Impact Factor: 3.27). 06/2008; 17(4):261-6. DOI: 10.1016/j.suronc.2008.03.004
Source: PubMed


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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    • "[32] [34] [35] The panel therefore recommends conservative surgery as the first option whenever suitable. Esthetic outcomes, body image changes and the impact on sexuality may be more relevant in young women: when mastectomy is indicated, skin-and nipple-sparing techniques with immediate breast reconstruction, when feasible, or other oncoplastic techniques can provide adequate oncological control while also addressing the cosmetic needs [36] [37]. There is no evidence of an increased false negative rate or a worse outcome in young patients undergoing sentinel lymph node biopsy (SLNB) [38] [39]. "
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    ABSTRACT: The 1st International Consensus Conference for Breast Cancer in Young Women (BCY1) took place in November 2012, in Dublin, Ireland organized by the European School of Oncology (ESO). Consensus recommendations for management of breast cancer in young women were developed and areas of research priorities were identified. This manuscript summarizes these international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
    Full-text · Article · Jan 2014
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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.
    Full-text · Article · Dec 2012 · World Journal of Surgical Oncology
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    • "Nipple-sparing mastectomy (NSM) is similar to SSM but spares the nipple-areolar complex (NAC), mandating removal of nipple-areolar (NA) ducts [21, 64] and leaving only the epidermis and dermis at the NA behind. Recommendations are that skin flaps in NSM should only be 2–3 mm in thickness at the NAC [21], with the technique facilitated by nipple eversion during dissection, and use of sharp dissection instead of electrocautery to limit thermal injury and increase NA preservation rates  [64]. "
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    ABSTRACT: Breast conservation therapy has been the cornerstone of the surgical treatment of breast cancer for the last 20 years; however, recently, the use of mastectomy has been increasing. Mastectomy is one of the most frequently performed breast operations, and with novel surgical techniques, preservation of the skin envelope and/or the nipple-areolar complex is commonly performed. The goal of this paper is to review the literature on skin-sparing mastectomy and nipple-sparing mastectomy and to evaluate the oncologic safety of these techniques. In addition, this paper will discuss the oncologic importance of margin status and type of mastectomy as it pertains to risk of local recurrence and relative need for adjuvant therapy.
    Full-text · Article · Jul 2012 · International Journal of Surgical Oncology
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