Preservation of nipple-areola complex in breast cancer--a clinicopathological assessment

Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR), which traditionally includes the nipple-areola complex (NAC), is the modern way of improving the cosmetic and aesthetic outcome of advanced breast cancer surgery. However, with nipple and areola lacking, it fails to simulate the original breast. This study is directed at exploring the possibility of NAC preservation in selected mastectomy patients.

A retrospective analysis of the breast specimens of 219 consecutive mastectomy patients was performed after categorising the tumour characteristics on the basis of their TNM staging. The relationship of malignant involvement of the NAC with positive regional lymph nodes (pN), tumour size (T), site, stage and skin involvement by the breast tumour was noted and analysed. Chi-square analysis was performed for different characteristics vis-à-vis NAC involvement. Two-sided lists, wherever possible, had been performed at the 5% level of significance and P values were evaluated.

The total frequency of malignant involvement of NAC was 44 (20%) out of 219. The frequency of NAC involvement in stage I and II tumours was found to be 9.38% compared to stage III tumours where it was 30%. The NAC was involved in 4 (2.5%) of 160 patients with peripheral tumours compared with 40 (68%) of 59 patients with tumours located centrally. Only 2 (1.5%) of 130 peripheral tumours bigger than 5 cm had malignant NAC involvement while the number in their central counterparts was much bigger (59%). Not a single breast cancer patient with skin involvement in the peripheral quadrants had any nipple-areola involvement.

NAC can be preserved in patients having stage I, II and III diseases with peripheral tumours less than 5 cm in size, irrespective of the nodal status and skin involvement.