title: When mastectomy becomes inevitable: the nipple-sparing approach.
abstract: The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.
authors.affiliation: Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20 141 Milan, Italy. jean.petit@ieo.it
authors.forename: J Y
authors.initials: JY
authors.lastname: Petit
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: R
authors.initials: R
authors.lastname: Orecchia
authors.forename: P C
authors.initials: PC
authors.lastname: Rey
authors.forename: S
authors.initials: S
authors.lastname: Martella
authors.forename: F
authors.initials: F
authors.lastname: Didier
authors.forename: F
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: M
authors.initials: M
authors.lastname: Rietjens
authors.forename: C
authors.initials: C
authors.lastname: Garusi
authors.forename: A
authors.initials: A
authors.lastname: Sonzogni
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: E
authors.initials: E
authors.lastname: Leida
authors.forename: R
authors.initials: R
authors.lastname: Lazzari
authors.forename: A
authors.initials: A
authors.lastname: Giraldo
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015412:Mastectomy, Segmental / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009558:Nipples / Q000601:surgery*