ABSTRACT
This chapter summarises the indications and surgical principles of a nipple-sparing approach to mastectomy. Nipple involvement and local recurrence in the nipple-areolar complex (NAC) have been the main concerns for patients and surgeons alike in the widespread adoption of nipple-sparing mastectomy (NSM) for patients with established cancer. When planning surgery with a patient, it is important that she is involved in the decision-making process and understands the potential risks and benefits of conserving the NAC. Although symmetrical, anatomical NAC positioning is a principal goal in NSM, it can be difficult to achieve. In a survey, NAC position was rated as the second most important aspect that patients wished they could change after undergoing NSM. So-called 'delay techniques' for NSM have been described whereby a retro-areolar biopsy is undertaken a few weeks before the NSM to render the nipple dependent on the blood supply from the skin rather than from the parenchyma.
