title: Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?
abstract: BACKGROUND
  We evaluated the risks and benefits of nipple-sparing mastectomy in a multiinstitutional experience in the settings of risk-reducing surgery and breast cancer treatment.
  
  
  METHODS
  We analyzed data on 123 patients who had undergone nipple-sparing mastectomy with breast reconstruction for prophylaxis (n=55), treatment of breast cancer (n=41), or both (n=27) at four large centers.
  
  
  RESULTS
  Median patient age was 45 years (range 22 to 70 years). There were 192 procedures (69 bilateral, 54 unilateral). Forty-four patients had invasive cancer; 20 had ductal carcinoma in situ (DCIS); 4 had phyllodes tumor. In all of these patients, the nipple tissue was cancer free on pathologic review. Median followup was 24.6 months (range 2.0 to 570.4 months). Local recurrence developed in two patients: one had DCIS in the upper-outer quadrant, with 71.8 months of followup; the other's cancer was invasive, in the upper-outer quadrant, with 6 months of followup. Distant metastasis developed in a third patient, who died 50 months after the procedure. Breast cancer developed in two patients after prophylactic mastectomy: one in the upper-outer quadrant at 61.8 months; one in the axillary tail at 24.4 months. No patients had recurrences in the nipple-areolar complex. Necrosis of the nipple was reported in 22 of 192 patients (11%) and it was judged minimal (less than one-third total skin of nipple) in 13 of 22 patients (59%). Overall cosmesis was judged by the patient and surgeon as good to excellent in the majority of patients. Level of satisfaction with cosmetic results was similar between prophylactic and treatment patients.
  
  
  CONCLUSIONS
  The risk of local relapse was very low in our series of nipple-sparing mastectomies performed for DCIS or invasive cancer. Nipple-sparing mastectomy in the risk-reducing and breast cancer-treatment settings may be feasible in selected patients and should be the subject of additional prospective clinical trials.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Virgilio
authors.initials: V
authors.lastname: Sacchini
authors.forename: José A
authors.initials: JA
authors.lastname: Pinotti
authors.forename: Alfredo C S D
authors.initials: AC
authors.lastname: Barros
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Alfonso
authors.initials: A
authors.lastname: Pluchinotta
authors.forename: Marianne
authors.initials: M
authors.lastname: Pinotti
authors.forename: Marcelo G
authors.initials: MG
authors.lastname: Boratto
authors.forename: Marco D
authors.initials: MD
authors.lastname: Ricci
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Ruiz
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Nisida
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.forename: Jean
authors.initials: J
authors.lastname: Petit
authors.forename: Paolo
authors.initials: P
authors.lastname: Arnone
authors.forename: Fabio
authors.initials: F
authors.lastname: Bassi
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Garcia-Etienne
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Borgen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009558:Nipples / Q000473:pathology; D017060:Patient Satisfaction; D003557:Phyllodes Tumor / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome