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Related Experiment Video

Updated: May 8, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Increasing eligibility for nipple-sparing mastectomy.

Suzanne B Coopey1, Rong Tang, Lan Lei

  • 1Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.

Annals of Surgical Oncology
|August 27, 2013
PubMed
Summary
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Nipple-sparing mastectomy (NSM) eligibility has expanded to include patients with higher BMI and larger breasts, with improved outcomes. This trend shows better patient selection and reduced nipple margin complications over time.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Surgery

Background:

  • Nipple-sparing mastectomy (NSM) criteria for patient eligibility are not standardized and vary based on individual patient and tumor characteristics.
  • Previous studies have indicated a need to better define eligibility for NSM to optimize outcomes and minimize complications.

Purpose of the Study:

  • To evaluate trends in patient eligibility for NSM over time.
  • To assess the impact of changing eligibility criteria on surgical outcomes, including nipple necrosis and local recurrence rates.
  • To determine if improved patient selection has led to better results in NSM procedures.

Main Methods:

  • A retrospective review of patients who underwent NSM between June 2007 and December 2012 was conducted.
  • Data collected included patient and tumor characteristics, complications (e.g., nipple necrosis), and recurrence rates.

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Last Updated: May 8, 2026

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  • Outcomes were compared between two periods: 2007-2010 and 2011-2012 to identify trends.

    • Main Results:

    • NSM was performed on 645 breasts in 370 patients, with indications including risk reduction (51.2%), invasive cancer (35.0%), and ductal carcinoma-in-situ (13.8%).
    • Total nipple necrosis occurred in 1.7% of breasts, and 3.7% required nipple removal due to positive margins.
    • While NSM was increasingly performed for cancer in patients with higher BMI and larger breasts in 2011-2012 compared to 2007-2010, nipple loss due to positive margins significantly decreased (p=0.027).

    Conclusions:

    • Eligibility for NSM has broadened to encompass patients with higher BMI and larger breasts without an increase in ischemic nipple loss.
    • A significant reduction in positive subareolar/nipple margins over time suggests improved patient selection for NSM.
    • These findings indicate that NSM can be safely expanded to a wider patient population with careful selection and surgical technique.