Nipple-sparing mastectomy in modern breast practice

Area of Science:

• Oncology
• Surgical Innovation
• Breast Cancer Management

Background:

• Breast cancer treatment has advanced from radical surgery to multidisciplinary approaches.
• Nipple sparing mastectomy (NSM) preserves the breast envelope and nipple-areola complex (NAC).
• NSM is an option for early-stage cancers without NAC involvement and high-risk patients.

Purpose of the Study:

• Critically review indications for NSM.
• Examine intra-operative protocols, radiotherapy planning, and limitations of NSM.
• Identify areas needing further investigation for NSM in breast cancer treatment.

Main Methods:

• Review of current literature and clinical practices regarding NSM.
• Analysis of patient selection criteria including imaging and pathology.
• Discussion of surgical techniques, complications, and radiotherapy considerations.

Main Results:

• Patient selection relies on MRI, mammographic tumor-nipple distance, and frozen section analysis.
• Tumor characteristics and institutional protocols guide NSM candidate inclusion.
• Nipple necrosis is a complication, reducible with specific incisions; altered sensation is common.

Conclusions:

• Standardization of preoperative assessment, surgical technique, and pathology sampling is needed.
• Multi-institutional prospective studies are essential to validate NSM's role in invasive breast cancer and DCIS.
• Further investigation into oncologic safety, functional, and aesthetic outcomes of NSM is required.