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Nipple-Sparing Mastectomy

Spear, Scott L. M.D.; Hannan, Catherine M. M.D.; Willey, Shawna C. M.D.; Cocilovo, Costanza M.D.

Plastic & Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - pp 1665-1673
doi: 10.1097/PRS.0b013e3181a64d94
Breast: Special Topic

Background: The debate over nipple-sparing mastectomy continues to evolve. Over the past several years, it has become more widely accepted, especially in the setting of prophylactic mastectomy, but its role in the treatment of breast cancer has only recently been reexamined.

Methods: Two indications for the procedure are discussed: prophylactic, for the high-risk patient; and the more controversial topic, therapeutic nipple-sparing mastectomy, for the patient with breast cancer. A review of the literature suggests that certain breast cancers may be amenable to retaining the nipple if they meet specific oncologic criteria: tumor size 3 cm or less, at least 2 cm from the nipple, not multicentric, and with clinically negative nodes. Moreover, newer technologies such as magnetic resonance imaging and preoperative mammotome biopsy may make the procedure even safer in this setting. Practical and technical aspects of the procedure are discussed, including patient selection.

Results: The accumulating data from multiple series of nipple-sparing mastectomy show that properly screened patients have a low risk of local cancer recurrence, that recurrences occur rarely in the nipple, and that recurrences in the nipple can be managed by removing the nipple.

Conclusions: Despite continued controversy and the need for more long-term outcome data, nipple-sparing mastectomy is a procedure that is gaining increasing visibility and acceptance. Provided that certain oncologic and practical criteria are applied, it has the potential for allowing less invasive surgery and improved cosmetic outcomes without increased oncologic risk in appropriately selected patients.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital, and the Departments of Plastic Surgery and Surgery, Georgetown University.

Received for publication March 25, 2008; accepted September 19, 2008.

Disclosures: Scott L. Spear, M.D., is a paid consultant to Allergan, LifeCell, and Ethicon. None of the other authors has any financial conflicts of interest.

Scott L. Spear, M.D., Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW 1PHC, Washington, D.C. 20007, spears@gunet.georgetown.edu

©2009American Society of Plastic Surgeons