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Inframammary Approach to Nipple-Areola–Sparing Mastectomy

Salibian, Arthur H. M.D.; Harness, Jay K. M.D.; Mowlds, Donald S. M.D., M.B.A.

Plastic and Reconstructive Surgery: November 2013 - Volume 132 - Issue 5 - p 700e–708e
doi: 10.1097/PRS.0b013e3182a4d64f
Breast: Original Article

Background: Different approaches have been advocated for performing nipple-areola–sparing mastectomy. The inframammary approach has been viewed as having limited applications, particularly in large breasts. The authors review their experience with nipple-areola–sparing mastectomy using the inframammary approach for different breast sizes.

Methods: Between 2005 and 2012, 118 nipple-areola–sparing mastectomies with staged implant-based reconstruction were performed in 80 consecutive patients. Patients with different breast sizes underwent inframammary nipple-areola–sparing mastectomy, except those patients who had very large breasts or those who requested a breast lift. Oncologic data related to tumor size, selection criteria, and recurrences are presented. All nipple-areola–sparing mastectomies and reconstructions were performed by the same surgeons (J.K.H. and A.H.S), who operated as a team in performing the mastectomies.

Results: Patients were followed up from 6 to 97 months (mean, 33.5 months). There were four recurrences (5 percent), three of which were attributed to the biological behavior of the tumor. The aesthetic outcomes of the reconstructions were analyzed based on nipple location, breast contour, and symmetry: 35 patients (44 percent) had a very good result, 28 (35 percent) had a good result, nine (11 percent) had a fair result, and eight (10 percent) had a poor result. Risk factors and complications affecting the final aesthetic outcome are discussed.

Conclusions: The inframammary approach for nipple-areola–sparing mastectomy is the authors’ procedure of choice for small, medium, and large breasts. The team approach to the mastectomy facilitates the procedure, reduces skin-related complications, and results in a better aesthetic outcome.


Orange, Calif.

From St. Joseph Hospital; and the Aesthetic and Plastic Surgery Institute and the Department of Surgery, University of California Irvine Medical Center.

Received for publication April 4, 2013; accepted May 13, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Arthur H. Salibian, M.D., 1310 Stewart Drive, Suite 211, Orange, Calif. 92868,

©2013American Society of Plastic Surgeons