Nipple-Sparing Mastectomies May Be Right for Some

THURSDAY Oct. 27, 2011 -- Nipple-sparing mastectomy is safe and effective for certain breast cancer patients and women who have their breasts removed because they're at high risk for breast cancer, according to a new study.

For both groups of women, the procedure provides a more natural looking and normal feeling reconstructed breast compared to other types of mastectomy, the Georgetown University Medical Center researchers said in a news release.

In nipple-sparing mastectomy, breast tissue is removed but surgeons preserve the breast skin and nipple areola complex, which includes the nipple and darker pigmented circle of skin that surrounds it. Typically, breast reconstruction is done immediately.

There have been concerns that this procedure might leave cancer cells under the nipple, which could put women at long-term risk. But this 21-year study of 162 nipple-sparing mastectomies conducted between 1989 and 2010 found no new cancers or cancer recurrences among the patients.

The study appears in the November issue of the journal Plastic and Reconstructive Surgery.

"The nipple-sparing technique is not appropriate for every patient depending upon their anatomy and type of breast pathology. Careful selection of the right patient for [nipple-sparing mastectomy] is an important element of success," Dr. Scott Spear, chairman of the plastic surgery department at Georgetown University Hospital, said in the release.

Another concern about nipple-sparing mastectomy is that the nipple areola complex (NAC) might not receive enough blood after the tissue and blood vessels below it are removed, resulting in tissue death (necrosis).

In this study, three NACs became necrotic and had to be removed. Four other NACs developed partial necrosis that required surgery, but the nipple and majority of the areola were preserved in all four cases.

"What we've learned from this review is that our established procedures and patient-selection protocol lead to favorable results," Spear said. "As more data become available, I think we'll see nipple-sparing mastectomy play a larger role, particularly in the prevention setting."

More information

The American Society of Clinical Oncology has more about breast cancer surgery options.

Posted: October 2011


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