ABSTRACT
INTRODUCTION The oncological rationale for removing the nipple-areola complex (NAC) as part of a therapeutic mastectomy for cancer relates to concerns that either potential cancer is present within the nipple-areola at the time of surgery or that cancer may subsequently form de novo in breast tissue within the retained nipple. Skin-sparing mastectomy is now widely accepted as a safe procedure when immediate reconstruction is considered. Immediate breast reconstruction should be offered as appropriate when mastectomy is mandated as surgical treatment for early stage breast cancer. However, recommendations governing refinements of this approach such as skin-sparing with NAC preservation should be cautiously applied in accordance with oncological principles. Attention must be paid to cancer excision with adequate margins and when tumors encroach on the NAC, either clinically or radiologically, surgical clearance may be compromised. In the absence of adequately powered studies, often with limited follow-up, preservation of the NAC as part of the skin envelope of the breast remains a controversial area. This is compounded to some extent by variation in surgical practice and judgment. Women who undergo nipple preservation may sense that the reconstructed breast feels more closely like their own. Careful attention to surgical technique and patient selection is essential to minimize rates of cancer recurrence within the retained NAC or formation of new cancers.
