Nipple-sparing mastectomy

Women after nipple-sparing mastectomy and implant reconstruction.

Nipple-sparing mastectomy (NSM), also known as nipple delay, is one of the surgical approaches for treating or preventing breast cancer. It involves the removal of all breast tissue, except the nipple-areolar complex (NAC), and the creation of new circulatory connections from the breast skin to NAC.[1] By preserving the NAC, NSM has provided patients with higher cosmetic expectations and the opportunity to undergo a mastectomy while maintaining a more natural appearance.[2]

The concept and technique of NSM were originally introduced by Freeman in the 1960s.[3] This technique has offered a viable alternative for patients who prioritize cosmetic outcomes, taking into consideration factors such as tumour size, breast size, and the presence of inflammatory signs.[4][5]

At the beginning of the surgery, various incision methods can be performed.[6] Followed by flap dissection for removal of the breast tissue, NAC is preserved during the whole procedure.[7] Breast reconstruction options, such as implant-based or flap-based reconstruction, can be pursued at last. After the surgery, proper monitoring of blood pressure and psychological support are needed.[8]

NSM is generally safe involving a low risk of necrosis of the NAC or surrounding skin due to interruptions of blood supply to it.[9] Necrosis has been reported from 6%-30% of patients.[10] The increased rates have an association with risk factors, including ptotic breasts, periareolar scars, large cup size, and previous radiation.[10]

  1. ^ Tokin, Christopher; Weiss, Anna; Wang-Rodriguez, Jessica; Blair, Sarah L. (2012). "Oncologic Safety of Skin-Sparing and Nipple-Sparing Mastectomy: A Discussion and Review of the Literature". International Journal of Surgical Oncology. 2012: 921821. doi:10.1155/2012/921821. ISSN 2090-1402. PMC 3405669. PMID 22848803.
  2. ^ Jensen, J. Arthur; Lin, Jennifer H.; Kapoor, Nimmi; Giuliano, Armando E. (2012). "Surgical Delay of the Nipple–Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy". Annals of Surgical Oncology. 19 (10): 3171–3176. doi:10.1245/s10434-012-2528-7. ISSN 1534-4681. PMID 22829005.
  3. ^ Freeman, Bromley S. (1962). "Subcutaneous Mastectomy For Benign Breast Lesions With Immediate Or Delayed Prosthetic Replacement". Plastic and Reconstructive Surgery. 30 (6): 676–682. doi:10.1097/00006534-196212000-00008. ISSN 0032-1052. PMID 13959443.
  4. ^ Lohsiriwat, Visnu; Petit, JeanYves (2012). "Nipple Sparing Mastectomy: from prophylactic to therapeutic standard". Gland Surgery. 1 (2): 759–779. doi:10.3978/j.issn.2227-684X.2012.06.02. ISSN 2227-8575. PMC 4115683. PMID 25083428.
  5. ^ Tousimis, Eleni; Haslinger, Michelle (2018). "Overview of indications for nipple sparing mastectomy". Gland Surgery. 7 (3): 28800–28300. doi:10.21037/gs.2017.11.11. ISSN 2227-8575. PMC 6006023. PMID 29998078.
  6. ^ Smith, Barbara L.; Coopey, Suzanne B. (2018). "Nipple-Sparing Mastectomy". Advances in Surgery. 52 (1): 113–126. doi:10.1016/j.yasu.2018.03.008. ISSN 1878-0555. PMID 30098607.
  7. ^ Kopkash, Katherine; Sisco, Mark; Poli, Elizabeth; Seth, Akhil; Pesce, Catherine (2020). "The modern approach to the nipple-sparing mastectomy". Journal of Surgical Oncology. 122 (1): 29–35. doi:10.1002/jso.25909. ISSN 1096-9098. PMID 32219847.
  8. ^ Parks, Lisa (2021). "Nipple-Sparing Mastectomy in Breast Cancer: Impact on Surgical Resection, Oncologic Safety, and Psychological Well-Being". Journal of the Advanced Practitioner in Oncology. 12 (5): 499–506. doi:10.6004/jadpro.2021.12.5.5. ISSN 2150-0878. PMC 8299789. PMID 34430060.
  9. ^ Lee, Samantha C.; Mendez-Broomberg, Karen; Eacobacci, Katherine; Vincoff, Nina S.; Gupta, Ekta; McElligott, Suzanne E. (2022). "Nipple-sparing Mastectomy: What the Radiologist Should Know". Radiographics. 42 (2): 321–339. doi:10.1148/rg.210136. ISSN 1527-1323. PMID 35179983.
  10. ^ a b Lee, Phoebe L.; Ma, Irene T.; Schusterman, Mark Asher II; Beiriger, Justin; Ahrendt, Gretchen; De La Cruz, Carolyn; Diego, Emilia J.; Steiman, Jennifer G.; McAuliffe, Priscilla F.; Gimbel, Michael L. (2023). "Surgical Nipple Delay and its Expanded Indications for Nipple-sparing Mastectomy". Plastic and Reconstructive Surgery – Global Open. 11 (1): e4783. doi:10.1097/GOX.0000000000004783. PMC 9857370. PMID 36699239.