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One Hundred Forty-Nine Procedures and Clinical Outcomes

Joseph P. Crowe, MD; Rebecca J. Patrick, MA; Randall J. Yetman, MD; Risal Djohan, MD

Arch Surg. 2008;143(11):1106-1110.

Objectives  To describe our experience with patients who underwent the nipple-sparing mastectomy procedure developed and standardized at our institution and to report clinical outcomes for those patients with a breast cancer diagnosis.

Design  Prospective study for consecutive nipple-sparing mastectomy procedures.

Setting  Multidisciplinary breast center at a large tertiary care facility.

Patients  One hundred ten consecutive patients underwent nipple-sparing mastectomy between July 2001 and June 2007.

Intervention  Nipple-sparing mastectomy was offered to carefully screened patients; the nipple-areola tissue was cored and sent for histologic frozen-section analysis intraoperatively.

Main Outcome Measures  Assessment of nipple-areola cored tissue for neoplastic involvement; postoperative stability of retained nipple-areola complex; and clinical outcomes.

Results  Data were available for 149 nipple-sparing mastectomies performed on 110 patients. No procedure performed for prevention had neoplastic involvement of the cored nipple-areola tissue, while 9 procedures performed for breast cancer treatment were found to have neoplastic involvement. Postoperatively, 2 patients had partial loss of the nipple-areola complex due to sloughing and a third patient developed an infection that required surgical removal of the nipple-areola complex. Among patients with breast cancer, none with ductal carcinoma in situ has developed a recurrence, while 4 patients with infiltrating breast cancer have, including 2 patients with distant metastases only, a third with a chest wall recurrence, and a fourth with an axillary recurrence.

Conclusion  A low incidence of neoplastic involvement of the nipple-areola cored tissue leads to successful completion of nipple-sparing mastectomy for most patients.

Author Affiliations: Departments of General Surgery–Breast Center (Dr Crowe and Ms Patrick) and Plastic Surgery (Drs Yetman and Djohan), Cleveland Clinic, Cleveland, Ohio.

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