title: Nipple-sparing mastectomy update: one hundred forty-nine procedures and clinical outcomes.
abstract: OBJECTIVE
  To describe our experience with patients who underwent the nipple-sparing mastectomy procedure developed and standardized at our institution and to report clinical outcomes for those patients with a breast cancer diagnosis.
  
  
  METHODS
  Prospective study for consecutive nipple-sparing mastectomy procedures.
  
  
  METHODS
  Multidisciplinary breast center at a large tertiary care facility.
  
  
  METHODS
  One hundred ten consecutive patients underwent nipple-sparing mastectomy between July 2001 and June 2007.
  
  
  METHODS
  Nipple-sparing mastectomy was offered to carefully screened patients; the nipple-areola tissue was cored and sent for histologic frozen-section analysis intraoperatively.
  
  
  METHODS
  Assessment of nipple-areola cored tissue for neoplastic involvement; postoperative stability of retained nipple-areola complex; and clinical outcomes.
  
  
  RESULTS
  Data were available for 149 nipple-sparing mastectomies performed on 110 patients. No procedure performed for prevention had neoplastic involvement of the cored nipple-areola tissue, while 9 procedures performed for breast cancer treatment were found to have neoplastic involvement. Postoperatively, 2 patients had partial loss of the nipple-areola complex due to sloughing and a third patient developed an infection that required surgical removal of the nipple-areola complex. Among patients with breast cancer, none with ductal carcinoma in situ has developed a recurrence, while 4 patients with infiltrating breast cancer have, including 2 patients with distant metastases only, a third with a chest wall recurrence, and a fourth with an axillary recurrence.
  
  
  CONCLUSIONS
  A low incidence of neoplastic involvement of the nipple-areola cored tissue leads to successful completion of nipple-sparing mastectomy for most patients.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, A80, Cleveland, OH 44195, USA. crowej@ccf.org
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Crowe
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Patrick
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Yetman
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009558:Nipples; D011446:Prospective Studies; D016896:Treatment Outcome