title: [Nipple-sparing mastectomy (subcutaneal mastectomy with preserving of the areolomammilar complex) like alternative of the modify radical mastectomy in selected cases].
abstract: BACKGROUND
  In the last ten years breast's surgery changed significantly. The different types mastectomy which conserve the skin and the halo and nipple are more and more popular. From oncology's point of view this kind of operations show similar results compared with the classical modified radical mastectomy, but they have significantly advantage to imrove the final aesthetic result and to reduce the psychological stress of surgery intervention for the patient. Our main goal is to make survey of medical data and to prove oncological radicality and reconstructive efficiency of nipple-sparing mastectomy (NSM) with one-moment reconstruction.
  
  
  METHODS
  In period 2006-2009 in our clinic to 52 patients with breast cancer or with high risk of occurrence is done NSM and one-moment reconstruction with prothesis or expander. Of this number five patients are operated bilateral. We selected patients with small to medium size breasts and tumor to 3 sm, distant at least 2 sm from NSM. On a stable preparation in two cases (3.8% of all cases) is established invasion of retro-mamilarian tissue with tumor cells which indicated excision of NSM on second stage. This cases are not included in our study. The adjuvant therapy is conducted in indications according with approved standards.
  
  
  RESULTS
  After 2-36 months period monitoring non of the patients showed local relapse. One of them (1.75%) receive distant metastases and died. Necrosis of NSM is observed in 13 patients (22.9%) and in all ot these cases it was partial and it was contained with conservative methods. In one case only (1.75%) the patient reported significant change in sensitivity of NSM. The final aesthetic result was evaluated subjectively of the patients and their doctors as very good or excellent in majority of cases.
  
  
  CONCLUSIONS
  Our results are similar with established from other collegues and support the thesis that conserve NSM with one-moment reconstruction is oncologycally justified operation which conserve the patients in good psychological condition, improving the quality of life and it's reasonable alternative of MRM in similar cases.
authors.forename: M
authors.initials: M
authors.lastname: Mladenov
authors.forename: P
authors.initials: P
authors.lastname: Chervenyakov
authors.forename: I
authors.initials: I
authors.lastname: Daskalova
mesh_terms: D001940:Breast / Q000473:pathology / Q000601:surgery*; D019928:Breast Implantation / Q000379:methods; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002031:Bulgaria; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000379:methods; D009364:Neoplasm Recurrence, Local; D009558:Nipples / Q000473:pathology / Q000601:surgery; D017060:Patient Satisfaction