title: When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications?
abstract: OBJECTIVE
  Nipple-sparing mastectomy (NSM) improves cosmetic results after mastectomy. As most consider advanced tumors, or tumors near the nipple-areola complex (NAC), as a contraindication for this type of surgery, we challenged this hypothesis.
  
  
  METHODS
  One hundred thirty-eight NSM were performed in 121 consecutive patients. In 122 procedures for cancer, patients were included if there was no evidence of NAC proximity (<1 cm), and if the retro-areolar margin was negative, even for locally advanced tumors or after neoadjuvant chemotherapy.
  
  
  RESULTS
  Total NAC necrosis occurred in six cases (4.3%). Additionally, NAC was removed after histological exam of the retro-areolar tissue in 19 cases (16% of cancer patients). Among 93 cases whose tumor-to-NAC distance was recorded, NAC was removed in 11/31 cases (35%) if the distance was 1 cm, and in 8/62 cases (12.9%) if it was more than 1 cm (P = 0.01). NAC was removed more frequently in the first half of the study (17/69 vs. 8/69: P = 0.05). At a median follow-up of 26 months for the cancer patient group, there was only one local recurrence (outside the NAC).
  
  
  CONCLUSIONS
  Our experience adds evidence that NSM is safe, if the retro-areolar resection margin is clear and maximal surgical clearance is performed.
authors.affiliation: Breast Unit, Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy. lfortunato@hsangiovanni.roma.it
authors.forename: Lucio
authors.initials: L
authors.lastname: Fortunato
authors.forename: Andrea
authors.initials: A
authors.lastname: Loreti
authors.forename: Renato
authors.initials: R
authors.lastname: Andrich
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Costarelli
authors.forename: Mostafà
authors.initials: M
authors.lastname: Amini
authors.forename: Massimo
authors.initials: M
authors.lastname: Farina
authors.forename: Elena
authors.initials: E
authors.lastname: Santini
authors.forename: Carlo E
authors.initials: CE
authors.lastname: Vitelli
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D012189:Retrospective Studies
keywords: breast cancer; breast reconstruction; mastectomy; nipple-sparing mastectomy; total skin-sparing mastectomy