Two‐hundred and fourteen cases of histologically proven Paget's disease of the breast were seen at Memorial Hospital during the period 1950 through 1968. Ninety‐six patients were without palpable masses, clinically, and 113 had Paget's disease of the nipple with palpable masses. Two thirds of the patients without palpable masses, clinically, had noninfiltrating carcinoma, and the majority of them had negative nodes in the axilla; accordingly, they have a good prognosis. Ninety percent of the patients with palpable masses had infiltrating carcinoma, and two thirds of them had positive nodes in the axilla. According to this study, modified radical mastectomy is the treatment of choice for the patient who does not have a palpable mass. Radical mastectomy should be performed on the patient who has a palpable mass.

Three hundred and fifty‐four patients with histologically proven infiltrating lobular carcinoma of the breast were seen at Memorial Hospital, New York City, between 1956 and 1970. This comprised 5.8% of all breast cancers seen during this interval. Infiltrating lobular breast cancer is found less frequently in the Negro female—3.7% vs. 5.8% for all breast cancer. Histologic differentiation from infiltrating duct carcinoma may be difficult. Clinical diagnosis is often complicated by its gross similiarty to “localized mastitis.” Bilaterality is more frequent with infiltrating lobular carcinoma—23% vs. 16% for infiltrating duct carcinoma. Infiltrating lobular carcinoma is lethal in its behavior, 5‐ and 10‐year salvage rates, after similar therapy, being slightly below those for infiltrating breast carcinoma generally. During its in‐situ stage, lobular carcinoma can be cured consistently by total mastectomy. When definitive surgical therapy is delayed until infiltrating breast cancer has developed, the patient is exposed to a greater long‐term risk because of the uncertain prognosis of infiltrating lobular carcinoma.

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Breast cancer is the most common malignant tumor among females in the USA, with one out of eight American females developing breast cancer in their lifetimes. The latest studies show that 212,920 new cases of invasive cancer developed in 2006, which is 2.5 times more common than the incidence of lung cancer, and that 40,970 females will die from this disease each year. Therefore, awareness of this cancer is an important health issue, with more women beginning to assess their risk of breast cancer, either informally or with instruments such as the GAIL model. The availability of genetic testing for BRCA-1 and BRCA-2 has revealed many women who are at significantly increased risk. Many aggressive surveillance programs have been developed using advanced MRI and ultrasound, and reductions in breast cancer risk of 50% or more have been proven using chemoprevention strategies with tamoxifen and raloxifene. However, many women are starting to seriously consider prophylactic mastectomy for near-total reduction of breast cancer risk. At our institution, we have developed a procedure for prophylactic subcutaneous mastectomy via an inframammary incision that spares the nipple and is combined with immediate silicone implant reconstruction with the assistance of Alloderm. In this article we will describe the procedure and some of the important issues surrounding its implementation from our experience.