Lobules in the nipple. Frequency and significance for breast cancer treatment

Subcutaneous mastectomy with nipple preservation has been advocated for the treatment of in situ lobular carcinoma. The rationale for not removing the nipple in these cases is the perception that lobules do not occur in the nipple. This study was undertaken to assess the frequency with which lobules occur in the nipple, exclusive of the areola. A routine vertical section of the nipple was reviewed in each of 101 consecutive mastectomies performed for breast carcinoma. One or more lobules was found in 17 percent of specimens. An additional independent observation of note was the presence of carcinoma in 13 percent of nipples, largely noninvasive. Coexistence of lobules and carcinoma was found in two cases. These data indicate that nipple preservation is not appropriate if mastectomy is performed to remove tissue at risk in the treatment of breast cancer. A procedure which removes the central part of the nipple or nipple reconstruction should be employed.