Update on the indications for nipple-sparing mastectomy

Area of Science:

• Oncology
• Plastic Surgery
• Breast Surgery

Background:

• Renewed interest in nipple-sparing mastectomy (NSM), combining skin-sparing mastectomy with nipple-areola complex preservation.
• NSM is considered oncologically safe for a subgroup of patients preferring mastectomy over breast-conserving surgery.
• Advanced techniques and surgical coordination yield excellent cosmetic outcomes and low complication rates.

Purpose of the Study:

• To evaluate the oncological safety and cosmetic outcomes of nipple-sparing mastectomy (NSM).
• To explore the potential role of NSM in both prophylactic and therapeutic settings for breast cancer.
• To identify the need for further research to establish consensus on NSM indications.

Main Methods:

• Review of reported experiences with newer nipple-sparing mastectomy techniques.
• Analysis of outcomes from limited series with small patient populations.
• Assessment of oncological safety, cosmetic results, and complication incidence.

Main Results:

• NSM can achieve excellent cosmetic results with low postoperative complications when performed with newer techniques and surgical coordination.
• Concerns persist regarding the risk of breast cancer development with prophylactic NSM and potential local control failure in therapeutic NSM.
• Limited reported series with small populations hinder the generation of a consensus on NSM indications.

Conclusions:

• Nipple-sparing mastectomy (NSM) shows promise as an oncologically safe option with good cosmetic results for select patients.
• The current role of NSM appears more defined in high-risk patients as a prophylactic procedure.
• Prospective studies are essential to definitively establish indications for NSM in both prophylactic and therapeutic contexts.