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Updated: Mar 29, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
What is the evidence behind conservative mastectomies?
Nicola Rocco1, Giuseppe Catanuto1, Maurizio Bruno Nava1
11 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy.
Conservative mastectomies like skin-sparing mastectomy (SSM) and nipple-areola complex (NAC)-sparing mastectomy (NSM) offer cosmetic benefits for breast cancer patients. Evidence suggests these techniques maintain oncological safety while improving body image.
Area of Science:
- Oncology
- Plastic Surgery
- Breast Surgery
Background:
- Conservative mastectomy techniques, including skin-sparing mastectomy (SSM) and nipple-areola complex (NAC)-sparing mastectomy (NSM), have gained acceptance for early breast cancer treatment.
- These methods aim for improved aesthetic outcomes and immediate reconstruction post-mastectomy.
Purpose of the Study:
- To investigate the evidence supporting the shift towards conservative mastectomy techniques.
- To evaluate the oncological safety and aesthetic outcomes of SSM and NSM compared to traditional mastectomy approaches.
Main Methods:
- A comprehensive literature review was conducted across multiple databases (Medline, Embase, Cochrane, WHO ICTRP, Clinicaltrials.gov).
- Included randomized controlled trials (RCTs), prospective cohorts, and retrospective series comparing conservative mastectomy techniques with breast-conservative surgery or modified radical mastectomy (MRM).
Main Results:
- The review analyzed 58 studies on NSM and immediate reconstruction and 10 studies on SSM and immediate reconstruction.
- Data on complication rates, NAC necrosis, and local/NAC recurrence were extracted for NSM and SSM.
- While RCTs are limited, available evidence from cohorts and series was synthesized.
Conclusions:
- Conservative mastectomies provide significant psychological advantages, enhancing cosmetic results and maintaining a positive body image.
- These techniques do not compromise the oncological safety typically associated with mastectomy for early-stage breast cancer.
- Further RCTs are recommended to strengthen the evidence base for conservative mastectomy approaches.
