title: Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved?
abstract: BACKGROUND
  Skin-sparing mastectomy (SSM), which involves the resection of the nipple/areolar complex with the breast parenchyma, improves the aesthetic outcome for breast cancer patients. Most patients undergoing SSM desire reconstruction of the nipple/areolar complex for symmetry. These data explore the possibility of preserving the areola in selected mastectomy patients.
  
  
  METHODS
  A retrospective analysis of 217 mastectomy patients was conducted to determine the frequency of malignant nipple and/or areola involvement. The association between nipple and/or areola involvement and prognostic factors, including tumor size, stage, nuclear grade, axillary nodal status, and tumor location, was evaluated.
  
  
  RESULTS
  The overall frequency of malignant nipple involvement was 23 of 217 (10.6%). In a subgroup of patients with tumors <2 cm, peripheral tumors, and with two positive nodes or less, the incidence of nipple involvement was 6.7%. When the nipple and areolar involvement were analyzed separately, only 2 of 217 patients had involvement of the areola (0.9%). All patients with areolar involvement had stage 3 breast cancer and were located centrally in the breast.
  
  
  CONCLUSIONS
  We conclude from these data that nipple preservation is not a reasonable option for mastectomy patients. However, preservation of the areola with mastectomy in selected patients warrants further study.
authors.affiliation: Department of Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA. rms2002@med.cornell.edu
authors.forename: Rache M
authors.initials: RM
authors.lastname: Simmons
authors.forename: Meghan
authors.initials: M
authors.lastname: Brennan
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Valencia
authors.initials: V
authors.lastname: King
authors.forename: Michael
authors.initials: M
authors.lastname: Osborne
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies