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Nipple-Sparing Mastectomy and Immediate Tissue Expander/Implant Breast Reconstruction

Chen, Constance M., M.D., M.P.H.; Disa, Joseph J., M.D.; Sacchini, Virgilio, M.D.; Pusic, Andrea L., M.D.; Mehrara, Babak J., M.D.; Garcia-Etienne, Carlos A., M.D.; Cordeiro, Peter G., M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1772-1780
doi: 10.1097/PRS.0b013e3181bd05fd

Background: The nipple is an uncommon site for breast cancer development, but the nipple-areola complex is routinely excised in breast cancer treatment. The authors evaluated the risks and benefits of nipple- or areola-sparing mastectomy with breast reconstruction.

Methods: The authors analyzed data on 115 consecutive nipple- or areola-sparing mastectomies with immediate tissue expander breast reconstruction performed in 66 patients from 1998 to 2008 at a single tertiary-care cancer center. Nipple-sparing mastectomies were performed for prophylaxis (n = 75) or treatment of disease (n = 40).

Results: Mean patient age was 45 years (range, 24 to 61 years) and mean follow-up time was 22 months (range, 2 weeks to 91 months). There were 115 nipple- or areola-sparing mastectomies (48 bilateral and 19 unilateral), including 111 nipple-sparing and four areola-sparing mastectomies. On pathologic review, 20 breasts had ductal carcinoma in situ, 20 breasts had invasive cancer, 11 breasts had lobular carcinoma in situ, one breast had phyllodes tumor, one breast had mucinous carcinoma, and 62 breasts were cancer-free. Incision placement was periareolar and radial (n = 61), inframammary (n = 25), omega type (n = 14), customized to include a previous scar (n = 10), or transareolar (n = 5). Of all 115 nipple- or areola-sparing mastectomies, six nipples were lost because of occult disease (5.2 percent), and four nipples were lost because of wound-healing problems (3.5 percent).

Conclusions: In the authors' series of nipple- and areola-sparing mastectomies performed for risk reduction or breast cancer, there was a low incidence of occult disease (5.2 percent). Nipple- and areola-sparing mastectomy may be feasible in selected patients and should be the subject of additional investigation.

New York, N.Y.

From the Plastic and Reconstructive Service and the Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.

Received for publication March 9, 2009; accepted June 29, 2009.

Presented at the 87th Annual Meeting of the American Association of Plastic Surgeons, in Boston, Massachusetts, April 5 through 8, 2008.

Disclosure:None of the authors has a financial interest to declare in relation to the content of this article.

Joseph J. Disa, M.D.; Memorial Sloan-Kettering Cancer Center; 1275 York Avenue; New York, N.Y. 10021;

©2009American Society of Plastic Surgeons