Nipple Sparing Mastectomy in Breast Cancer Patients
Keywords:
Nipple sparing mastectomy, Nipple areolar complex, Retroareolar tissue, Necrosis, Necrosis, Nipple involvementAbstract
The loss of nipple areolar complex (NAC) can affect the quality of life of the patient. Nipple sparing mastectomy (NSM) removes all of the breast tissue but preserves the skin of the breast and the NAC. These techniques were developed to treat breast cancer patients. Three factors that should be considered include: oncological safety, patient safety, and the cosmetic outcome and quality of life.The prevalence of nipple involvement in breast cancer is up to 58%. Risk factors for nipple involvement include: tumor size > 5cm, distance between tumor and nipple < 2 to 3 cm, multicentricity of tumor, presence of lymphovascular invasion and presence of lymph node metastasis. The local recurrence rate of cancer is up to 12% with NAC recurrence rate up to 2%. The role of adjuvant RT at the NAC is still being debated. Absolute contraindications to NSM include: tumor invasion to skin and NAC, Paget's disease and inflammatory breast cancer. In the present article we review current evidence for the safety of NSM, as well the surgical technique used in our institution. We conclude that to ensure safety, maintain a low local recurrence, and achieve a good cosmetic outcome and good quality of life, proper selection of patients for NSM is key.
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