Jensen JA, Orringer JS, Giuliano AE.
John Wayne Cancer Institute, Santa Monica, CA, USA.
Ann Surg Oncol 2011;18:1665–70.
Editor’s note: The safety and practicality of nipple-sparing mastectomy (NSM) are controversial. In the present article, the authors report their experience with NSM in 99 patients, with a mean follow-up of 5 years. They describe their oncological criteria for patient selection and review the surgical results of NSM. Candidates for NSM included women who had a diagnosis of invasive breast cancer (IBC) or non-IBC who were interested in the possibility of preserving the nipple areolar complex (NAC). Those with tumor involvement of the skin or nipple, IBC or non-IBC immediately underneath the NAC, or bloody nipple discharge were not eligible. All women were told that the NAC would be preserved as a full-thickness flap if possible and a subareolar biopsy specimen would be obtained at the time of mastectomy. If the frozen section analysis of the subareolar tissue showed cancer, the nipple would be removed at the time of mastectomy. If frozen section analysis showed no cancer but permanent section showed disease postoperatively, subsequent removal of the nipple would be performed. All subjects were cautioned that the blood supply to the nipple comes largely from the breast tissue itself and an attempt at nipple preservation might result in postoperative necrosis of the nipple requiring subsequent removal even with no sign of cancer.