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