title: Nipple-sparing mastectomy: technique and results of 54 procedures.
abstract: OBJECTIVE
  The rationale for removal of the nipple-areolar complex (NAC) during total mastectomy centers on long-standing concerns about possible neoplastic involvement of the NAC and its postoperative viability. Nipple-sparing mastectomy (NSM) combines a skin-sparing mastectomy with preservation of the NAC, intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total mastectomy. Neoplastic involvement of the NAC can be predicted before surgery and assessed during the operation, and sustained postoperative viability of the NAC is likely with appropriate surgical technique.
  
  
  RESULTS
  Fifty-four NSMs with immediate reconstruction were attempted among 44 patients. Six NAC core specimens revealed neoplastic involvement on frozen section analysis, resulting in conversion to total mastectomies. Forty-five of the 48 completed NSMs maintained postoperative viability of the NAC; 3 NACs had partial loss.
  
  
  CONCLUSIONS
  Nipple-sparing mastectomy is a reasonable option for carefully screened patients.
authors.affiliation: Departments of General Surgery and Plastic Surgery, The Cleveland Clinic Breast Center, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. crowej@ccf.org
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Crowe
authors.forename: Julian A
authors.initials: JA
authors.lastname: Kim
authors.forename: Randall
authors.initials: R
authors.lastname: Yetman
authors.forename: Jillian
authors.initials: J
authors.lastname: Banbury
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Patrick
authors.forename: Deborah
authors.initials: D
authors.lastname: Baynes
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D009558:Nipples; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome