Delayed nipple-sparing modified subcutaneous mastectomy: rationale and technique

Area of Science:

• Surgical Oncology
• Plastic and Reconstructive Surgery

Background:

• Nipple-areola complex (NAC) preservation during mastectomy presents a significant surgical challenge.
• Maintaining NAC viability is difficult due to compromised blood supply after removing mammary tissue.
• Existing methods often struggle to balance oncological safety with aesthetic and functional preservation of the NAC.

Purpose of the Study:

• To introduce and evaluate a novel two-step surgical procedure for NAC preservation during mastectomy.
• To assess the safety, simplicity, and effectiveness of this technique in oncological and reconstructive outcomes.
• To determine the suitability of the technique for prophylactic mastectomy and early-stage breast cancer.

Main Methods:

• A two-step surgical approach is detailed, beginning with a mini-invasive outpatient procedure under local tumescent anesthesia.
• The first step involves autonomizing the NAC's vascular supply by detaching the galactophore stalk and coagulating the deep vascular plexus.
• The second step, under general anesthesia, entails en-bloc mastectomy with capsular removal, axillary assessment, and subpectoralis prosthesis placement.

Main Results:

• The described technique effectively preserves the nipple-areola complex (NAC) during mastectomy.
• It ensures oncological safety by removing all mammary tissue while maintaining NAC viability.
• The procedure is deemed safe, simple, and effective, particularly for prophylactic mastectomy and select Stage I breast cancers.

Conclusions:

• The proposed two-step surgical technique offers a viable solution for NAC preservation in mastectomy.
• It successfully balances the oncological requirements of mastectomy with the reconstructive goal of NAC viability.
• This method is recommended for prophylactic mastectomy and early-stage breast cancer cases meeting specific criteria.