Nipple-sparing Mastectomy: What the Radiologist Should Know

Area of Science:

• Radiology
• Oncology
• Breast Surgery

Background:

• Nipple-sparing mastectomy (NSM) offers oncological safety, improved cosmesis, and quality of life for breast cancer patients.
• Indications for NSM have expanded, with nipple involvement being a key contraindication.
• Accurate imaging assessment of nipple involvement is critical for selecting NSM candidates and preventing local recurrence.

Purpose of the Study:

• To evaluate imaging features for predicting nipple involvement in breast cancer.
• To determine the efficacy of multimodality breast imaging, especially MRI, in assessing nipple involvement for NSM candidacy.

Main Methods:

• Review of imaging features predictive of nipple involvement.
• Assessment of tumor to nipple distance, enhancement patterns, and nipple retraction.
• Evaluation of breast MRI performance, including specificity and negative predictive value.

Main Results:

• Tumor to nipple distance, enhancement between malignancy and nipple, and nipple retraction are key predictors.
• Breast MRI shows high specificity and negative predictive value for nipple involvement.
• Multimodality imaging aids in identifying appropriate candidates for NSM.

Conclusions:

• Accurate imaging assessment of nipple involvement is vital for NSM.
• Breast MRI is a valuable tool for determining nipple involvement and guiding NSM decisions.
• Proper patient selection based on imaging improves NSM outcomes and reduces recurrence risk.