ABSTRACT
Indications for nipple-sparing mastectomy continue to evolve with an increasing number of patients undergoing this technique. Although positive postoperative nipple margins can occur, especially in patients with ductal carcinoma in situ, nipple-sparing mastectomy has significantly improved the outcomes of breast reconstruction. Mastectomy remains unavoidable in certain circumstances, perhaps most commonly in patients with multicentric disease at presentation. Nipple preservation is an extension of the skin-sparing concept and represents the next step in conservative forms of mastectomy. The role of focal radiotherapy to treat the retained nipple in therapeutic mastectomy is uncertain. A review by Janssen and colleagues of adjuvant radiotherapy after nipple-sparing mastectomy shows wide variation. Studies of oncological outcome after nipple-sparing mastectomy are limited by differences in patient selection criteria, duration of follow-up, and variation in adjuvant treatment regimens. Skin-sparing and nipple-sparing mastectomy are part of the armamentarium of reconstructive breast surgery after cancer, but require careful patient selection.
