When mastectomy becomes inevitable: the nipple-sparing approach

Area of Science:

• Oncology
• Plastic Surgery
• Radiotherapy

Background:

• Nipple-sparing mastectomy (NSM) aims to improve quality of life after mastectomy.
• Preserving the nipple areola complex (NAC) is a key goal in breast cancer surgery.
• Novel radiosurgical techniques are being explored for breast cancer treatment.

Purpose of the Study:

• To evaluate a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy for nipple preservation.
• To assess the clinical, aesthetic, oncological, and psychological outcomes of this combined approach.
• To determine patient and surgeon satisfaction rates with nipple preservation and breast reconstruction.

Main Methods:

• Three hundred nipple-sparing mastectomies (NSM) were performed, including invasive (58%) and in situ (42%) carcinomas.
• A radiosurgical technique combining subcutaneous mastectomy with intraoperative radiotherapy was employed.
• Clinical complications, aesthetic results, oncological outcomes, and psychological impact were systematically recorded.

Main Results:

• NAC necrosis occurred in 10 cases (total) and 29 cases (partial); 12 NACs were removed.
• Nine infections (3%) and 10 prosthesis removals were observed.
• Good aesthetic and oncological results were reported by 82.3% of patients and 84.8% of surgeons; 85.5% were satisfied with NAC preservation.

Conclusions:

• The combined radiosurgical approach for NSM shows promising aesthetic and oncological results with high patient satisfaction.
• While complications like NAC necrosis and infection can occur, they were manageable.
• Further research may optimize this technique to minimize complications and maximize functional and aesthetic preservation.