Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Abstract

Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and careful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon’s experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon’s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.

Keywords: Breast reconstruction, Skin-sparing mastectomy, Nipple-sparing mastectomy, Outcome, Complications, Silicone breast implants, Tissue expanders, Oncoplastic surgery

Core tip: In selected patients, nipple-sparing mastectomy (NSM) has allowed an adequate oncologic control with satisfactory aesthetic outcome. In addition, utilizing the native breast skin optimizes the aesthetic outcome of the reconstructed breast and minimizes post-mastectomy deformity. The satisfactory results are due to a close collaboration with the oncological surgical team in terms of incision selection and mastectomy flap dissection. In general, choice of reconstructive procedure requires careful consideration of various patient related factors, including: breast volume, degree of ptosis, areolar size, patient preference and expectation, and surgeon experience. With careful patient selection and well-planned surgical technique, NSM can provide satisfactory outcomes with acceptable complication rates. However, available data demonstrate that NSM can be safely performed for breast cancer treatment in selected cases. Although NSM reduces the psychological trauma associated with nipple-areola complex resection, the oncologic safety as well as functional and aesthetic outcomes needs additional investigation. Thus, additional clinical studies and longer follow-up are necessary to define consistent selection criteria for NSM.