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Nipple-Sparing Mastectomy in 99 Patients With a Mean Follow-up of 5 Years

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The safety and practicality of nipple-sparing mastectomy (NSM) are controversial.

Methods

Review of a large breast center’s experience identified 99 women who underwent intended NSM with subareolar biopsy and breast reconstruction for primary breast cancer. Outcome was assessed by biopsy status, postoperative nipple necrosis or removal, cancer recurrence, and cancer-specific death.

Results

NSM was attempted for invasive cancer (64 breasts, 24 with positive lymph nodes), noninvasive cancer (35 breasts), and/or contralateral prophylaxis (50 breasts). Twenty-two nipples (14%) were removed because of positive subareolar biopsy results (frozen or permanent section). Seven patients underwent a pre-NSM surgical delay procedure because of increased risk for nipple necrosis. Reconstruction used transverse rectus abdominis myocutaneous flaps (56 breasts), latissimus flaps with expander (35 breasts), or expander alone (58 breasts). Of 127 retained nipples, 8 (6%) became necrotic and 2 others (2%) were removed at patient request. There was no nipple necrosis when NSM was performed after a surgical delay procedure. At a mean follow-up of 60.2 months, all 3 patients with recurrence had biopsy-proven subareolar disease and had undergone nipple removal at original mastectomy. There were no deaths.

Conclusions

Five-year recurrence rate is low when NSM margins (frozen section and permanent) are negative. Nipple necrosis can be minimized by incisions that maximize perfusion of surrounding skin and by avoiding long flaps. A premastectomy surgical delay procedure improves nipple survival in high-risk patients. NSM can be performed safely with all types of breast reconstruction.

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Acknowledgment

Supported by funding from the Avon Foundation, Margie and Robert E. Petersen Foundation (Los Angeles, CA), QVC and the Fashion Footwear Association of New York Charitable Foundation (New York, NY), Mrs. Lois Rosen (Los Angeles, CA), the Associates for Breast and Prostate Cancer Studies (Santa Monica, CA), Maria Lucia and Fernando Diez Barroso (Beverly Hills, CA), Randa and Ghassan Ghandour (Athens, Greece), and the John Wayne Cancer Institute Auxiliary.

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The authors declare no conflict of interest.

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Correspondence to Armando E. Giuliano MD.

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Jensen, J.A., Orringer, J.S. & Giuliano, A.E. Nipple-Sparing Mastectomy in 99 Patients With a Mean Follow-up of 5 Years. Ann Surg Oncol 18, 1665–1670 (2011). https://doi.org/10.1245/s10434-010-1475-4

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  • DOI: https://doi.org/10.1245/s10434-010-1475-4

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