title: Increasing eligibility for nipple-sparing mastectomy.
abstract: BACKGROUND
  Eligibility for nipple-sparing mastectomy (NSM) varies widely on the basis of patient and tumor factors.
  
  
  METHODS
  Review of patients undergoing NSM from June 2007 to December 2012 at our institution was performed. Patient and tumor characteristics, complications, and recurrences were collected. NSM from 2007 to 2010 and 2011 to 2012 were compared to assess trends in eligibility and outcomes over time.
  
  
  RESULTS
  NSM was performed on 645 breasts in 370 patients. Indications were risk reduction in 330 (51.2 %), invasive cancer in 226 (35.0 %), and ductal carcinoma-in situ in 89 (13.8 %) breasts. Fifty-one (13.8 %) patients had positive lymph nodes. Twenty-seven (7.3 %) patients received neoadjuvant chemotherapy. Forty-eight (7.4 %) breasts had prior radiotherapy. Total nipple necrosis occurred in 11 (1.7 %) breasts. Twenty-four (3.7 %) breasts had nipples removed as a result of positive subareolar/nipple margins. At 22 months' mean follow-up, local recurrence occurred in 4 of 156 (2.6 %) breasts operated on for cancer through 2011. No recurrences involved the nipple. NSM performed in 2011-2012 (n = 475) compared to 2007-2010 (n = 170), were more often for cancer, in patients with higher body mass index, and on larger breasts (p < 0.001). There was no significant difference in total nipple necrosis rates between groups. Nipple loss due to positive subareolar/nipple margins was significantly less in 2011-2012 (p = 0.027).
  
  
  CONCLUSIONS
  Eligibility for NSM has expanded to include women with higher body mass index and larger breasts, with no increase in nipple loss due to ischemia. Rates of positive subareolar margins have decreased over time, even though NSM is being performed more frequently for cancer, suggesting improved patient selection.
authors: Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors: Suzanne B
authors: SB
authors: Coopey
authors: Rong
authors: R
authors: Tang
authors: Lan
authors: L
authors: Lei
authors: Phoebe E
authors: PE
authors: Freer
authors: Kari
authors: K
authors: Kansal
authors: Amy S
authors: AS
authors: Colwell
authors: Michele A
authors: MA
authors: Gadd
authors: Michelle C
authors: MC
authors: Specht
authors: William G
authors: WG
authors: Austen
authors: Barbara L
authors: BL
authors: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult