Nipple-Sparing Mastectomy Update: One Hundred Forty-Nine Procedures and Clinical Outcomes

• Published in: Archives of surgery (Chicago. 1960) Vol. 143; no. 11; pp. 1106 - 1110
• Main Authors: Crowe, Joseph P, Patrick, Rebecca J, Yetman, Randall J, Djohan, Risal
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.11.2008
• Subjects: Adult; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Clinical outcomes; Disease-Free Survival; Female; Follow-Up Studies; General aspects; Humans; Mastectomy; Mastectomy, Subcutaneous; Medical sciences; Middle Aged; Nipples; Postoperative period; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Treatment Outcome; Medicine; Prognosis; Treatment; Mammilla; Methodology; Surgery; Mastectomy; Breast; Evolution; Procedure; Mammary gland
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.143.11.1106

OBJECTIVES To describe our experience with patients who underwent the nipple-sparing mastectomy procedure developed and standardized at our institution and to report clinical outcomes for those patients with a breast cancer diagnosis. DESIGN Prospective study for consecutive nipple-sparing mastectomy procedures. SETTING Multidisciplinary breast center at a large tertiary care facility. PATIENTS One hundred ten consecutive patients underwent nipple-sparing mastectomy between July 2001 and June 2007. INTERVENTION Nipple-sparing mastectomy was offered to carefully screened patients; the nipple-areola tissue was cored and sent for histologic frozen-section analysis intraoperatively. MAIN OUTCOME MEASURES Assessment of nipple-areola cored tissue for neoplastic involvement; postoperative stability of retained nipple-areola complex; and clinical outcomes. RESULTS Data were available for 149 nipple-sparing mastectomies performed on 110 patients. No procedure performed for prevention had neoplastic involvement of the cored nipple-areola tissue, while 9 procedures performed for breast cancer treatment were found to have neoplastic involvement. Postoperatively, 2 patients had partial loss of the nipple-areola complex due to sloughing and a third patient developed an infection that required surgical removal of the nipple-areola complex. Among patients with breast cancer, none with ductal carcinoma in situ has developed a recurrence, while 4 patients with infiltrating breast cancer have, including 2 patients with distant metastases only, a third with a chest wall recurrence, and a fourth with an axillary recurrence. CONCLUSION A low incidence of neoplastic involvement of the nipple-areola cored tissue leads to successful completion of nipple-sparing mastectomy for most patients.Arch Surg. 2008;143(11):1106-1110-->