Nipple-areolar complex-sparing mastectomy: feasibility, patient selection, and technique.
BACKGROUND
We assessed the feasibility, patient selection, and technique of nipple-areolar complex (NAC)-sparing mastectomy. This dynamic article includes a video that demonstrates that sentinel node biopsy or axillary dissection can be performed through the mastectomy incisions or through a separate axillary incision.


METHODS
The University of Texas M. D. Anderson Cancer Center initiated a prospective study investigating the feasibility of performing NAC-sparing mastectomy in the setting of prophylaxis and breast cancer treatment. Patients selected were at low risk for skin/NAC necrosis and NAC involvement with tumor.


RESULTS
Preliminary results of 54 breasts that underwent NAC-sparing mastectomy showed a NAC necrosis rate of 7.2%. One patient who underwent NAC-sparing prophylactic mastectomy was found to have ductal carcinoma-in-situ that was not present at the nipple base. At a median follow-up of 15 months, there has been no NAC recurrence, which is similar to other reported series of 0% to 2%. Results were comparable with other small prospective series.


CONCLUSIONS
NAC-sparing mastectomy can be performed effectively while maintaining NAC viability. The risk of leaving residual breast tissue or occult tumor with the NAC is probably low if margin assessment is performed at the base or central core of the NAC. Long-term follow-up is forthcoming on these procedures. To achieve optimal cosmetic results with oncologic safety, NAC-sparing mastectomy should only be performed in carefully selected patients.
Babiera
Gildy
G
Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, TX, USA. gvbabiera@mdanderson.org
Simmons
Rache
R
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D013781:Texas; D016896:Treatment Outcome