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Technique and Results of 54 Procedures

Joseph P. Crowe, Jr, MD; Julian A. Kim, MD; Randall Yetman, MD; Jillian Banbury, MD; Rebecca J. Patrick, MA; Deborah Baynes, PA-C

Arch Surg. 2004;139:148-150.

Hypothesis  The rationale for removal of the nipple-areolar complex (NAC) during total mastectomy centers on long-standing concerns about possible neoplastic involvement of the NAC and its postoperative viability. Nipple-sparing mastectomy (NSM) combines a skin-sparing mastectomy with preservation of the NAC, intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total mastectomy. Neoplastic involvement of the NAC can be predicted before surgery and assessed during the operation, and sustained postoperative viability of the NAC is likely with appropriate surgical technique.

Results  Fifty-four NSMs with immediate reconstruction were attempted among 44 patients. Six NAC core specimens revealed neoplastic involvement on frozen section analysis, resulting in conversion to total mastectomies. Forty-five of the 48 completed NSMs maintained postoperative viability of the NAC; 3 NACs had partial loss.

Conclusion  Nipple-sparing mastectomy is a reasonable option for carefully screened patients.

From the Departments of General Surgery (Drs Crowe and Kim and Mss Patrick and Baynes) and Plastic Surgery (Drs Yetman and Banbury), The Cleveland Clinic Breast Center, The Cleveland Clinic Foundation, Cleveland, Ohio.

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