title: The Nipple-Areola Preserving Mastectomy: A Multistage Procedure Aiming to Improve Reconstructive Outcomes following Mastectomy.
abstract: Ischemia of the nipple-areola complex (NAC) and periareolar tissue is commonly seen following tissue-preserving mastectomies for small invasive and noninvasive cancers. The nipple-areola preserving mastectomy is a multistage procedure in which the NAC and central mastectomy flap tissue is surgically delayed to improve the survivability in patients undergoing mastectomies followed by reconstruction.
  
  
  METHODS
  We conducted a retrospective chart review of 20 patients undergoing the 2-stage nipple-areola preserving mastectomy: the first stage comprised undermining the NAC and raising the breast skin flaps, with placement of a silicone sheet in the dissected pocket. The second stage followed 2-3 weeks after the NAC delay, with patients undergoing nipple-sparing mastectomies.
  
  
  RESULTS
  Mean age was 46.2 years (range, 23-59 years). Indications included breast cancer in 18 patients and BRCA gene mutation prophylaxis in 2 patients. None were actively smoking. Mean time between delay of flaps and breast reconstructions was 16 days (range, 10-35 days). One patient underwent bilateral nipple resection at the time of mastectomies due to a subareolar nipple biopsy positive for ductal carcinoma in situ. One patient underwent left nipple excision after a skin nipple biopsy was positive for metaplasia. No signs of NAC vascular compromise were observed in any of the cases.
  
  
  CONCLUSIONS
  Our 2-stage approach benefits patients undergoing nipple-sparing mastectomy, especially those at high-risk, by safely increasing survivability of the native breast skin envelope and NAC, while improving oncologic outcomes by identification of subareolar malignancies and sentinel node status before mastectomy and reconstruction.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Texas School of Medicine at Houston, Texas.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Texas School of Medicine at Houston, Texas.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Reis
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Texas School of Medicine at Houston, Texas.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Sato
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Texas School of Medicine at Houston, Texas.
authors.forename: Sean G
authors.initials: SG
authors.lastname: Boutros