title: Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early-stage breast cancer.
abstract: BACKGROUND
  Psychological effects of mastectomy for women with breast cancer have driven treatments that optimize cosmesis while strictly adhering to oncologic principles. Although skin-sparing mastectomy is oncologically safe, questions remain regarding the use of nipple-areola complex (NAC)-sparing mastectomy (NSM). We prospectively evaluated NSM for patients undergoing mastectomy for early-stage breast cancer or risk reduction.
  
  
  METHODS
  We enrolled 33 early-stage breast cancer and high-risk patient; 54 NSMs were performed. NAC viability and surgical complications were evaluated. Intraoperative and postoperative pathologic assessments of the NAC base tissue were performed. NAC sensory, cosmetic and quality of life (QOL) outcomes were also assessed.
  
  
  RESULTS
  Twenty-one bilateral and 12 unilateral NSMs were performed in 33 patients, 37 (68.5%) for prophylaxis and 17 (31.5%) for malignancy. Mean age was 45.4 years. Complications occurred in 16 NACs (29.6%) and 6 skin flaps (11.1%). Operative intervention for necrosis resulted in 4 NAC removals (7.4%). Two (11.8%) of the 17 breasts with cancer had ductal carcinoma-in-situ at the NAC margin, necessitating removal at mastectomy. All evaluable patients had nipple erection at 6 and 12 months postoperatively. Cosmetic outcome, evaluated by two plastic surgeons, was acceptable in 73.0% of breasts and 55.8% of NACs, but lateral displacement occurred in most cases. QOL assessment indicated patient satisfaction.
  
  
  CONCLUSIONS
  NSM is technically feasible in select patients, with a low risk for NAC removal resulting from necrosis or intraoperative detection of cancer, and preserves sensation and QOL. Thorough pathologic assessment of the NAC base is critical to ensure disease eradication.
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jamie L
authors: JL
authors: Wagner
authors: Regina
authors: R
authors: Fearmonti
authors: Kelly K
authors: KK
authors: Hunt
authors: Rosa F
authors: RF
authors: Hwang
authors: Funda
authors: F
authors: Meric-Bernstam
authors: Henry M
authors: HM
authors: Kuerer
authors: Isabelle
authors: I
authors: Bedrosian
authors: Melissa A
authors: MA
authors: Crosby
authors: Donald P
authors: DP
authors: Baumann
authors: Merrick I
authors: MI
authors: Ross
authors: Barry W
authors: BW
authors: Feig
authors: Savitri
authors: S
authors: Krishnamurthy
authors: Mike
authors: M
authors: Hernandez
authors: Gildy V
authors: GV
authors: Babiera
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D009558:Nipples / Q000601:surgery*; D059351:Organ Sparing Treatments; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D040242:Risk Reduction Behavior; D016896:Treatment Outcome