Total Skin Sparing (Nipple Sparing) Mastectomy: What is the Evidence?

The surgical treatment of breast cancer has evolved from radical mastectomy with routine removal of the nipple-areolar complex (NAC) to breast conservative therapy with preservation of the breast and NAC. Each step along this evolutionary process was met with criticism, skepticism, controversy, anger, emotion, and often bitter and impassioned debate. Today we find ourselves at yet another therapeutic decision point: the management of the skin of the nipple-areolar complex in mastectomy. Enhanced understanding of the pathogenesis of breast cancer coupled with rising interest in improved cosmesis has led to the investigation of the skin-sparing and nipple-sparing mastectomy as potential modifications to conventional mastectomy.