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J Surg Oncol. 2013 Sep;108(4):207-12. doi: 10.1002/jso.23390. Epub 2013 Aug 1.

When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications?

Author information

1
Breast Unit, Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy. lfortunato@hsangiovanni.roma.it

Abstract

BACKGROUND AND OBJECTIVES:

Nipple-sparing mastectomy (NSM) improves cosmetic results after mastectomy. As most consider advanced tumors, or tumors near the nipple-areola complex (NAC), as a contraindication for this type of surgery, we challenged this hypothesis.

METHODS:

One hundred thirty-eight NSM were performed in 121 consecutive patients. In 122 procedures for cancer, patients were included if there was no evidence of NAC proximity (<1 cm), and if the retro-areolar margin was negative, even for locally advanced tumors or after neoadjuvant chemotherapy.

RESULTS:

Total NAC necrosis occurred in six cases (4.3%). Additionally, NAC was removed after histological exam of the retro-areolar tissue in 19 cases (16% of cancer patients). Among 93 cases whose tumor-to-NAC distance was recorded, NAC was removed in 11/31 cases (35%) if the distance was 1 cm, and in 8/62 cases (12.9%) if it was more than 1 cm (P = 0.01). NAC was removed more frequently in the first half of the study (17/69 vs. 8/69: P = 0.05). At a median follow-up of 26 months for the cancer patient group, there was only one local recurrence (outside the NAC).

CONCLUSIONS:

Our experience adds evidence that NSM is safe, if the retro-areolar resection margin is clear and maximal surgical clearance is performed.

KEYWORDS:

breast cancer; breast reconstruction; mastectomy; nipple-sparing mastectomy; total skin-sparing mastectomy

PMID:
23913775
DOI:
10.1002/jso.23390
[Indexed for MEDLINE]

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