Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction: Oncologic or Technical Problem?

Skin-, nipple-, and areola-sparing mastectomy

“…LR ranged from 2% to 24%, while DR ranged from 1.4% to 20%. Overall patient survival ranged from 76.4% to 100% [13,[22][23][24]. Benediktsson and Perbeck [23] reported much higher LR and DR rates, and the lower overall survival compared to other studies was due to subcutaneous mastectomy being used, which the authors attributed to comparatively reduced rates of adjuvant radiation use.…”

“…Sacchini described four different skin incisions for NSM, including an inferior or superior periareolar incision with lateral extension, which offers good surgical exposure but may compromise blood supply to the flap periphery and areola; transareolar with perinipple and lateralmedial extension, with the possible sequelae of perinipple artery division or scarring; transareolar and transnipple with extensions; or a mammary crease incision inferiorly or laterally, which may offer the best preservation of flap vascularity [13]. Radial transareolar incisions have been associated with reduced NAC loss and improved surgical outcomes [14,15].…”

“…One study reported NAC necrosis as high as 11%, almost half of which was in the setting of TRAM reconstruction. As in SSM, other possible complications include flap or skin necrosis, wound infection, and implant loss [13].…”

“…Importantly, tension on the skin via subcutaneous implants may impact blood supply to the skin and NAC. Tissue expanders and muscle flaps such as latissumus dorsi, TRAM, and DIEP have been utilized, although there appears to be lower complication rates with initial tissue expander use [13,14]. Sacchini et al [13] investigated 192 NSMs in 123 patients receiving either subpectoral or subcutaneous implants, tissue expanders, or TRAM reconstructions.…”

“…Reported rates of malignancy involvement within the nipple range from 0% to 58%, depending on the size of the primary breast tumor, location, multicentricity, and lymph node positivity [13,[16][17][18][19][20]. Our group retrospectively investigated 217 mastectomy specimens for malignant involvement of the nipple, areola, or both.…”