Surgical Delay of the Nipple-Areolar Complex: Maximizing Nipple Viability Following Nipple-Sparing Mastectomy While Determining Clear Subareolar Margin
Nipple-sparing mastectomy has gained wide acceptance following the realization that it provides the oncological benefits of mastectomy with the cosmetic benefits of conserving the breast skin. However, some patients are regarded as poor candidates for this procedure based upon risk factors such as macromastia, microvascular disease, previous scars around the nipple, and active cigarette smoking. In addition, some patients are told that their cancers are too close to the nipple without any clinical proof. Performing a surgical delay of the nipple-areolar complex and surrounding breast tissues allows the breast cancer team to stimulate the rerouting of blood supply to the tissues to be preserved while simultaneously obtaining a definitive biopsy of the subareolar tissue. Thus, patients who are often believed to be at high risk for nipple-sparing mastectomy can often have the procedure safely performed.
- 3.Hartmann LC, Sellers TA, Schaid DJ, Frank TS, Soderberg CL, Sitta DL, Frost MH, Grant CS, Donohue JH, Woods JE, McDonnell SK, Vockley CW, Deffenbaugh A, Couch FJ, Jenkins RB. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93:1633–7.CrossRefPubMedGoogle Scholar
- 10.Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMedGoogle Scholar
- 15.Sacchini V, Pinotti JA, Barros A, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC, Veronesi P, Petit J, Arnone P, Bassi F, Disa JJ, Garcia-Etienne CA, Borgen PI. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203:704–14.CrossRefPubMedGoogle Scholar
- 28.Gnudi MT, Webster JP. The life and times of Gaspare Tagliacozzi, surgeon of Bologna 1545–1599. New York: Herbert Reichner; 1950. p. 110–1.Google Scholar
- 31.Velander E. Vascular changes in tubed pedicles: an animal experimental study. Acta Chir Scand Suppl. 1964;24(Suppl):322.Google Scholar