The Nipple is Just Another Margin

Nipple-sparing mastectomy: A contemporary perspective

“…Recent critical analyses have suggested that the only true independent preoperative predictors are clinical or radiographic evidence of involvement of the NAC . As such, several authors have proposed expanding the indications for NSM, such that these are the only absolute contraindications, provided that intraoperative pathologic evaluation is performed .…”

“…Amara et al send the core of the nipple and the subareolar tissue as separate margins . Coopey and Smith advocate raising the areola at the level of the dermis and “grasping the [nipple] duct bundle with a curved clamp immediately below the NAC dermis [and] sharply dividing the tissue along both sides of the clamp” to obtain a margin . Assessment of the nipple margin can be performed by frozen or permanent section.…”

“…In these cases, the margin can be assessed within the context of the overall tumor stage and anticipated adjuvant treatment. When the nipple margin is positive, the NAC can be removed, the margin can be re‐excised, the nipple can be radiated, or the patient can be observed . Removal of the NAC is straightforward and can be performed at the time of the mastectomy or at a second stage, such as during a tissue expander to implant exchange .…”

Nipple-sparing mastectomy in women at high risk of developing breast cancer

“…Gland Surg 7(3):325-336 gs.amegroups.com of all breast tissue is an unattainable goal (67), though given the increasing risk with increasing thickness of skin flaps (65) surgeons must avoid the temptation to leave excessively thick flaps in the interests of better cosmesis. While histological studies have also shown terminal ductal lobular units (TDLUs) in the nipple (68)(69)(70), the surface area of epithelium retained in the nipple is likely to be substantially less than under the skin flaps (71). In a recent series of 150 patients (298 breasts) undergoing NSM for risk-reduction, occult disease was found in only 4 patients (2.7% of which 2 were in situ and one invasive disease).…”

Surgical Delay of the Nipple–Areolar Complex in High-risk Nipple-sparing Mastectomy Reconstruction

“…More women are undergoing NSM today, 8 , 9 and a number of solutions have been proposed by various authors to minimize the risk of NAC necrosis. Spear et al 10 described a staged approach for patients with significant ptosis or macromastia in which a mastopexy or reduction was performed at least 4 weeks (average, 3.4 months) before the mastectomy.…”