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Is nipple-sparing mastectomy a safe and acceptable option for women undergoing prophylactic mastectomy?
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Procedure is safe, reduces risk
About 90% of the patients we see for prophylactic risk reduction surgery, not cancer, end up having what we call a total nipple areola-sparing mastectomy. We do a full mastectomy in the same way we would if we took the nipple, and we preserve the nipple complex and do a retroareolar-biopsy at the time of surgery to make sure there is nothing left behind. In our experience over the past 30 years, no one that we have seen has developed a breast cancer after a nipple-sparing procedure. The risk reduction has been significant, obviously. We feel comfortable leaving the nipple complex and making sure we biopsy it to be sure there is nothing there. We obtain preoperative MRIs on everybody and we feel comfortable that with good surveillance, no one will develop breast cancer.
C. Andrew Salzberg, MD, is Assistant Professor of Surgery at New York Medical College.
Patient should be given the choice
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Our philosophy is that a mastectomy only removes a percentage of the breast tissue, not 100%. If we choose to leave a small amount of breast tissue in order to preserve the nipple, it may be worth the small additional risk to have the nipple and areola intact. The patient should be given that choice to preserve the nipple based on a risk assessment of leaving that small amount of additional breast tissue, unless, of course, breast cancer actually involves that tissue. We subscribe to the concept that the skin is a separate tissue from the breast tissue; it is in proximity, but separate. Incisions should be made according to principles of skin tailoring widely accepted in the plastic surgery field and all skin excision must be justified by cancer invasion or proximity. The wise keyhole pattern is the basis for all incisions from periareolar to a complete inverted “T” pattern. Transverse incisions and lines of Langer are obsolete.
Joel Aronowitz, MD, is Chief of Plastic Surgery at Cedars Sinai Medical Center in Los Angeles.