Nipple sparing mastectomy techniques: a literature review and an inframammary technique

Abstract

Nipple sparing mastectomy (NSM) has quickly become an accepted technique for patients with selected cancers and for risk reducing surgery. Much of its surgical acceptance over the last decade has been based on the low risk of nipple areolar complex (NAC) occurrence in breast cancer patients. Improved patient satisfaction due to improved cosmetic outcomes with reconstruction have also driven its popularity. We reviewed current English journals to determine the NSM techniques which achieve the lowest complications, best outcomes, and best patient satisfaction. We researched studies showing reductions in complications with improved surgical techniques and patient selection which have been implicated in improved results. In the studies reviewed, incision placement, away from the nipple, resulted in the lowest rates of ischemic nipple complications and the best cosmetic outcomes. The effect of other factors such as surgeon experience and thickness of skin flap development were more difficult to prove. Leaving a 2-3 mm rim of tissue around the nipple bundle was shown to help preserve the nipple vascularity. Lower complication rates with improved outcomes and patient satisfaction were reported in the literature in patients with B or smaller cup sizes, non-smokers, and patients with lower body mass index (BMI). Incision placement, away from the nipple, with preservation of a 2-3 mm rim of tissue around the nipple bundle along with careful patient selection were the most significant variables reviewed which helped to lower complications rates of NSM. Coordinated surgical planning with the breast and plastic surgeons to determine the best surgical approach for each individual patient is necessary to obtain the best results. Although short-term oncologic follow-up seems to be acceptable, longer follow-up will still be needed to define the best breast cancer surgical candidates for the nipple sparing approach.

Timing between Breast Reconstruction and Oncologic Mastectomy—One Center Experience

“…Regarding complications, initially, skin and nipple necrosis were considered to be too high, but after being used worldwide, it was emphasized that these two complications have a rate up to 10% and can be treated conservatively, saving the nipple. The most important steps to avoid complications are to make the incisions far from the nipple and to use the inframammary fold, this being demonstrated by Garwood et al (2009), but also by Colwell et al(2014) in their studies [13]. In our clinic, this intervention is starting to be used with high frequency due to the fact the patients are presenting in early stages of the disease.…”

“…Even though NSM was considered to have a high oncologic risk, it has been accepted as a reconstructive option in selected patients [12]. This technique is used in younger patients with early breast cancer stages or after prophylactic mastectomy [13].It can be done in one or two surgical steps, but most of the surgeons prefer the one-stage method due to its low overall costs, outstanding outcomes, and low revision rates [12]. Regarding complications, initially, skin and nipple necrosis were considered to be too high, but after being used worldwide, it was emphasized that these two complications have a rate up to 10% and can be treated conservatively, saving the nipple.…”

How to do an immediate prepectoral implant reconstruction with the TiLoop bra pocket

“…The technique for nipple‐sparing mastectomies has been well described in the literature . Briefly, an inframammary (Fig.…”

“…The technique for nipple-sparing mastectomies has been well described in the literature. 9,10 Briefly, an inframammary (Fig. S1a) or lateral mammary crease incision is made, approximately 8-10 cm in length.…”

Identifying the dissection plane for mastectomy—description and visualization of our technique

“…The technique is changing from always including the nipple-areola complex (NAC) to an acceptance of nipple sparing mastectomy in risk reducing mastectomies as well as in selected cancer patients. There is, however, an ongoing discussion about how much skin and subcutaneous tissue should be resected to perform an adequate oncological safe mastectomy, while still leaving viable skin flaps (5)(6)(7)(8)(9)(10)(11).…”