Nipple Pathology in Total Skin-Sparing Mastectomy

Abstract

Concurrent excision of the nipple and an inferolateral incision increase the incidence of skin flap necrosis. Delaying nipple excision may prove to be a safer option.

Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

“…All 281 cases were eligible for inclusion. We found all cases of NSM in the study by Gunnarsson et al 24 eligible for this review and enrolled 38 cases of risk-reducing NSM reconstructed with the use of ADM. From the study by Wong et al, 27 we included 44 cases of TSSM performed through an inferior-lateral incision. Olson et al 26 included 65 cases of NSM with ADM. All patients had prior breast surgery.…”

“… 21 Gunnarsson et al 24 only included nonsmoking women treated with risk-reducing mastectomy and presented complication rates that were considerably lower than in all other studies included in this review. In contrast, Wong et al 27 only included cases treated therapeutically and presented considerably higher complication rates. This suggests that ADM use in NSM is a relatively safe procedure in healthy women.…”

Trends and controversies in multidisciplinary care of the patient with breast cancer

“…Initial recommendations were for complete excision of the nipple areolar complex; however some authors suggest that this can be done with excision of the nipple itself and preservation of the areola (177). If the tumor is felt to be close to the nipple, a lateral or perioareolar incision can be used to minimize risk for skin necrosis if nipple excision is ultimately needed (178). Insufficient data exists to support use of radiation rather than excision for an involved nipple margin and nipple involvement alone is not an indication for PMRT (179).…”