This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Nipple‐sparing mastectomy. BJS 2010; 97: 305-316.
Published: 25th January 2010
Authors: J. E. Rusby, B. L. Smith, G. P. H. Gui
Background
Although effective local control is the primary goal of surgery for breast cancer, the long‐term aesthetic outcome is also important. Nipple‐sparing mastectomy aims to address this, but there is no consensus on its clinical application. Evidence relating to oncological safety, surgical technique and early data on aesthetic outcome was reviewed.
Method
The review was based on a PubMed search using the terms ‘nipple‐sparing’ or ‘subcutaneous mastectomy’ and ‘breast cancer’.
Results
Large pathological studies report occult nipple involvement with cancer in 5·6–31 per cent, reflecting variation in inclusion criteria. Recent clinical series with careful patient selection report local recurrence in less than 5 per cent of patients. The incidence of cancer in the retained nipple after risk‐reducing mastectomy is less than 1 per cent. Nipple necrosis rates range up to 8 and 16 per cent for total and partial necrosis respectively. Variations in outcome result from differences in extent of resection, placement of incisions and type of breast reconstruction.
Conclusion
Nipple‐sparing mastectomy is an acceptable technique for women undergoing risk‐reducing mastectomy. In the therapeutic setting, it may be offered to patients with smaller tumours far from the nipple and favourable pathological features. Women should be counselled about nipple necrosis and the potential for local recurrence. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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