Nipple-sparing mastectomy: indications, oncologic safety

The locoregional treatment of breast cancer has rapidly evolved from disfiguring approaches to nipple-sparing mastectomy (NSM) in selected patients. The goal of the nipple-sparing mastectomy procedure is to remove all glandular breast tissue in order to maximize oncologic therapy, while leaving the nipple-areola complex (NAC) in place in order to optimize aesthetics of the breast. The procedure is gaining popularity around the world, both for treatment of known breast cancer and for prophylaxis in high risk patients. This article reviews indications and patient selection criteria, surgical techniques, as well as oncologic outcomes of the NSM procedure. NSM requires multidisciplinary collaboration amongst breast cancer specialties both preoperatively and postoperatively. The patient should be counseled regarding possibility of NAC removal in the event of retroareolar malignancy identified on frozen section pathology. The patient should also be counseled regarding potential loss of sensation and ischemia in the postoperative period that may require NAC excision. Patient satisfaction remains after NSM high, particularly when compared to the skin-sparing (without sparing of the NAC) mastectomy. The American Society of Breast Surgeons has established a NSM Registry, in order to prospectively collect data on metrics utilized, surgical techniques, and oncologic as well as aesthetic outcomes so that evidence based outcome measures for this procedure can be evaluated.