Nipple-sparing mastectomy

Background: Although effective local control is the primary goal of surgery for breast cancer, the long‐term aesthetic outcome is also important. Nipple‐sparing mastectomy aims to address this, but there is no consensus on its clinical application. Evidence relating to oncological safety, surgical t...

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Bibliographic Details
Published in:British journal of surgery 2010-03, Vol.97 (3), p.305-316
Main Authors: Rusby, J. E., Smith, B. L., Gui, G. P. H.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Breast Neoplasms - surgery
Female
General aspects
Humans
Intraoperative Care
Mastectomy - methods
Medical sciences
Necrosis
Nipples - pathology
Nipples - surgery
Patient Satisfaction
Patient Selection
Risk Assessment
Sensation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the genital tract and mammary gland
Treatment Outcome
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Summary:Background: Although effective local control is the primary goal of surgery for breast cancer, the long‐term aesthetic outcome is also important. Nipple‐sparing mastectomy aims to address this, but there is no consensus on its clinical application. Evidence relating to oncological safety, surgical technique and early data on aesthetic outcome was reviewed. Methods: The review was based on a PubMed search using the terms ‘nipple‐sparing’ or ‘subcutaneous mastectomy’ and ‘breast cancer’. Results: Large pathological studies report occult nipple involvement with cancer in 5·6–31 per cent, reflecting variation in inclusion criteria. Recent clinical series with careful patient selection report local recurrence in less than 5 per cent of patients. The incidence of cancer in the retained nipple after risk‐reducing mastectomy is less than 1 per cent. Nipple necrosis rates range up to 8 and 16 per cent for total and partial necrosis respectively. Variations in outcome result from differences in extent of resection, placement of incisions and type of breast reconstruction. Conclusion: Nipple‐sparing mastectomy is an acceptable technique for women undergoing risk‐reducing mastectomy. In the therapeutic setting, it may be offered to patients with smaller tumours far from the nipple and favourable pathological features. Women should be counselled about nipple necrosis and the potential for local recurrence. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. More evidence of benefit needed
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.6970