90th Annual Meeting Abstracts
What is the Role of Nipple Sparing Mastectomy?
Baiba J Grube, MD, *Deepak Narayan, MD, *Carla J Christy, MD, *Gary Price, MD, *Richard Restifo, MD, *Stephano Fusi, MD, *Zeno Chicarilli, MD, Donald R Lannin, MD
Yale University, New Haven, CT
Objective: Rates of mastectomy and bilateral mastectomy are increasing, and renewed emphasis is being placed on cosmetic outcome. Nipple sparing mastectomy is gaining acceptance as an oncologically safe and cosmetically pleasing option.
Design: Case series
Setting: University affiliated Breast Center
Patients: All nipple sparing mastectomies performed at a University affiliated Breast Center between December 2006 and April 2009.
Main outcome measures: Technical aspects, indications, cosmesis, complication rate, cancer recurrence rate
Results: Twenty three patients underwent 37 nipple sparing mastectomies (NSM). Indications for surgery were as follows: unilateral NSM for unilateral cancer 3/23 (13%), bilateral NSM for unilateral cancer 8/23 (35%), contralateral prophylactic NSM at the time of a non-NSM mastectomy for cancer 6/23 (26%), bilateral prophylactic NSM for BRCA mutation 6/23 (26%). Reconstructions consisted of tissue expanders in 28 cases, permanent implants in 6, and DIEP flaps in 3. In 4 cases with large or ptotic breasts, the nipple was repositioned on a de-epithelialized dermal flap. Partial or complete superficial nipple necrosis occurred in 5/37 (13%) of breasts. Risk factors for necrosis included macromastia, ptosis, smoking, and previous radiation therapy. In all cases, the nipple was allowed to heal by secondary intention, and the cosmetic result was still satisfactory. Overall the cosmetic result was judged to be excellent in 18 patients (78%). Frozen section was performed at the base of the nipple and was negative in all cases. One patient had tumor cells approaching the subareolar margin on permanent section, and the nipple was subsequently removed. There have been no recurrences to date.
Conclusions: Nipple sparing mastectomy is well tolerated and provides excellent cosmesis. Indications for use in therapeutic and prophylactic mastectomies are evolving.