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Review
. 2015 Dec;4(6):528-40.
doi: 10.3978/j.issn.2227-684X.2015.04.12.

Nipple areola complex sparing mastectomy

Camilla Rossi  1 , Matteo Mingozzi  1 , Annalisa Curcio  1 , Federico Buggi  1 , Secondo Folli  1
Affiliations
Review

Nipple areola complex sparing mastectomy

Camilla Rossi et al. Gland Surg. 2015 Dec.

Abstract

Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes.

Keywords: Breast cancer (BC); breast conservation; breast surgery; mastectomy; outcome.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Skin incisions. (A) Periareolar with lateral extension; (B) transareolar with lateral extension; (C) transareolar/transnipple; (D) infra-mammary crease; (E) italic S.
Figure 2
Figure 2
Hydrodissection of the areola.
Figure 3
Figure 3
Nipple-areola-complex isolation. (A,B) Duct bundle dissection; (C) nipple eversion; (D) nipple coring.
Figure 4
Figure 4
Surgical delay procedure. (A) Preoperative drawing: area of dissection; (B) preparation of the retroareolar and periareolar skin flap; (C) retroareolar biopsy; (D) skin flap.
Figure 5
Figure 5
Surgical delay procedure: our experience. (A,B) Preoperative; (C,D) post-surgical delay and nipple sparing mastectomy.
Figure 6
Figure 6
Monolateral nipple sparing mastectomy. (A,B) Left nipple sparing mastectomy and right implant augmentation; (C,D) right nipple sparing mastectomy and left implant augmentation.
Figure 7
Figure 7
Bilateral nipple sparing mastectomy and immediate reconstruction with prosthesis.
Figure 8
Figure 8
Bilateral nipple sparing mastectomy and a two-stage reconstruction.
See this image and copyright information in PMC

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