Abstract
In the last century, breast-cancer surgery underwent a dramatic development, starting from the initial approaches of radical surgery to the more recent codification of a series of conservative treatments that do not invalidate oncologic radicality. In 1894, Halsted [1] delineated radical mastectomy, which remained the standard treatment for breast cancer for many years. This operation, involving the removal of all the breast tissue (en bloc removal of the breast and overlying skin, both the pectoralis major and minor muscles and the axillary lymph nodes from Berg level I to III) was a fundamental shift in the surgical treatment of this disease (local disease control), but it was also a symbol of destruction, of a large wound, not only in surgical terms, suffered by the patient. In 1948, Patey and Dyson [2] of Middlesex Hospital, London, proposed an alternative approach to reduce the morbidity of Halsted’s operation (with the preservation of the pectoralis major muscle and the removal of the pectoralis minor muscle, the axillary lymph nodes could equally be removed). This was perhaps the first shift toward a more local conservative surgery.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Halsted WS (1898) Clinical and histological study of certain adenocarcinomata of the breast: and a brief consideration of the supraclavicular operation and of the results operations for cancer of the breast from 1889 to 1898 at the Johns Hopkins Hospital. Ann Surg 28:557–576
Patey DH, Dyson WH (1948) The prognosis of the carcinoma of the breast in relation to type of operation performed. Br J Cancer 2:7–13
Madden JL (1965) Modified radical mastectomy. Surg Gynecol Obstet 121:221–230
Veronesi U, Saccozzi R, Del Vecchio et al (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl l Med 30:6–11
Audretsch W, Rezai M, Kolotas C et al (1998) Tumor-specific immediate reconstruction in breast cancer patients. Perspect Plast Surg 11:71–100
Freeman BS (1962) Subcutaneous mastectomy for benign breast lesions with immediate delayed prosthetic replacement. Plast Reconstr Surg 30:676–682
Hinton CP, Doyle PJ, Blamey RW et al (1984) Subcutaneous mastectomy for primary operable breast cancer. Br J Surg 71:469–472
Toth B, Lappert P (1991) Modified skin incision for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstruct. Surg 87:1048–1053
Kroll SS et al (1991) The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg Gynecol Obstet 172:17–20
Verheyden CN (1998) Nipple sparing mastectomy of large breast. ASPS American Society of Plastic Surgeons 101:1494–1500
Petit JY, Veronesi U, Martella S et al (2003) The nipple sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori 89:288–291
Murthy V, Chamberlain RS (2012) Nipple-sparing mastectomy in modern breast practice. Clinical anatomy 26:56–65
Garcia-Etienne C, Borgen PI (2006) Update ion the indications for nipple-sparing mastectomy. J Supportive Oncology 4:226–230
Rusby JE, Smith BL, Gui GPH (2010) Nipple-sparing mastectomy. Brit J Surg 97:305–316
Niemeyer M, Ettl J, Plattner B et al (2010) Nipple-sparing mastectomy-Extended indications and limitations. Breast Care 5:253–258
Gerber B, Krause A, Dieterich M et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 23:20–27
Cunnick GH (2006) Oncological considerations of skin sparing mastectomy. Int Semin Surg Oncol 25:3:14
Cunnick GH (2003) Skin-sparing mastectomy. Am J Surg 188:78–84
Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ (2001) Nipple-sparing mastectomy in breast cancer: a viable option. Eur J Surg Oncol 27:521–526
Gerber B, Krause A, Dieterich M et al (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249:461–468
Simmons RM, Brennam M, Christoo P et al (2002) Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved. Ann Surg Oncol 9:165–168
Morimoto T, Komaki K, Inui K et al (1985) Involvement of nipple and areola in early breast cancer. Cancer 55:2459–2463
Voltura A, Tsangaris TN, Rosson GD et al (2008) Nipple-sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria. Ann Surg Oncol 15:3396–3401
Edge SB (2009) Nipple-sparing mastectomy: how often is the nipple involved? J Clin Oncol 27:4930–4932
Sacchini V, Pinotti JA, Barros A et al (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 203:704–714
Harness JK, Vetter TS and Salibian AH (2011) Areola and nipple-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol 18:917–922
Vyas JJ, Chinoy RF and Vaidya JS (1998) Prediction of nipple and areola involvement in breast cancer. Eur J Surg Oncol 24:15–16
Simmons RM (2004) Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg 188:403–406
Sappey MPG (1885) Anatomie, physiologie, pathologie des vaisseaux lymphatiques. Paris: A. DeLayaye et E. Larosnier, 1874
Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582
Wellings SR (1980) A hypothesis of the origin of the human breast cancer from the terminal ductal lobular unit. Pathol Res Pract 166:515–535
Stolier A, Wang J (2007) Terminal duct lobular units are scarce in the nipple: implications for prophylactic nipple-sparing mastectomy: terminal duct lobular units in the nipple. Ann Surg Onc 15:438–442
Rusby JE, Brachtel EF, Michaelson JS et al (2007) Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg 194:433–437
Rusby JE, Brachtel EF, Michaelson JS et al (2007) Breast duct anatomy in the human nipple: three-dimensional patterns and clinical implications. Breast Cancer Res Treat 106:171–179
Beer GM, Varga Z, Budi S et al (2002) Incidence of the superficial fascia and its relevance in skin sparing mastectomy. Cancer 94:1619–1625
Petit JY, Veronesi U, Orecchia R et al (2012) Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia. Ann Oncol 23:2053–2058
Lohsiriwat V, Martella S, Rietjens M et al (2012) Paget’s disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis. Ann Surg Oncol 19:1850–1855
De Lorenzi F, Yamaguchi S, Petit JY et al (2005) Evaluation of skin perfusion after nipplesparing mastectomy by indocyanine green dye. Preliminary results, J Exp Clin Cancer Res 24:347–354
Folli S, Curcio A, Buggi F et al (2012) Improved sub-areolar breast tissue removal in nipplesparing mastectomy using hydrodissection. Breast 21:190–193
Vlajcic Z, Zic R, Stanec S et al (2005) Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 55:240–244
Kneubil MC, Lohsiriwat V, Curigliano G et al (2012) Risk of locoregional recurrence in patients with false-negative frozen section or close margins of retroareolar specimen in nipplesparing mastectomy. Ann Surg Oncol 19:4117–4123
Algaithy ZK, Petit JY, Lohsiriwat V et al (2012) Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? EJSO 38:125–129
Babiera G, Simmons R (2010) Nipple-areolar complex-sparing mastectomy: feasibility, patient selection, and technique. Ann Surg Oncol 17:245–248
Brachtel EF, Rusby JE, Michaelson JS et al (2009) Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol 27:4948–4954
Luo D, Hat J, Lathan B et al (2010) The accuracy of intraoperative subareolar frozen section in nipple-sparing mastectomies. The Ochsner Journal 10:188–192
Chen CM, Disa JJ, Sacchini V et al (2009) Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg 124:1772–1780
Yang SJ, Eom JS, Lee TJ et al (2012) Recipient vessel selection in immediate breast reconstruction with free abdominal tissue transfer after nipple-sparing mastectomy. Arch Plast Surg 39:216–221
Carlson GW, Bostwick III J, Styblo TM et al (1997) Skin sparing mastectomy. Ann Surg 5:570–578
Carlson GW (2003) Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol 10:108–112
Toth BA, Forley BG, Calabria R (1999) Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 104:77–84
Torresan RZ, Dos Santos CC, Okamura H et al (2005) Evaluation of residual glandular tissue after skin-sparing mastectomies. Ann Surg Oncol 12:1037–1044
Carlson GW (2011) Technical advances in skin sparing mastectomy. Int J Surg Oncol 2011:396901
Hunter JE, Malata CM (2007) Refinements of the Lejour vertical mammaplasty skin pattern for skin-sparing mastectomy and immediate breast reconstruction. J Plast Reconstr Surg 60:471–481
Nava M, Cortinovis U, Ottolenghi J et al (2006) Skin-reducing mastectomy. Plast Reconstr Surg 118:603–610
Nava M, Ottolenghi J, Pennati A et al (2011) Skin/nipple sparing mastectomies and implantbased breast reconstruction in patients with large and ptotic breast: oncological and reconstructive results. The Breast 21:267–271
Di Candia M, Lie KH, Forouhi P, Malata CM (2010) Experience with the Wise mammaplasty skin resection pattern in skin sparing mastectomy and immediate breast reconstruction for large breast volumes. Int J Surg 9:41–45
Liu TS, Crisera CA, Jaco H et al (2010) Staged Wise-pattern Skin Excision for reconstruction of the large and ptotic breast. Plast Reconstr Surg 126:1831–1839
Jensen JA, Lin JH, Kapoor N, Giuliano AE (2012) Surgical delay of the nipple-areolar complex: a powerful technique to maximize nipple viability following nipple-sparing mastectomy. Ann Surg Onc 19:3171–3176
Benediktsson KP, Perbeck L (2008) Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg 34:143–148
Tokin C, Weiss A, Wang-Rodriguez J, Blair S (2012) Oncologic safety of skin and nipple sparing mastectomy: discussion and review of the literature. Int J Surg Oncol 2012:921821
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Italia
About this chapter
Cite this chapter
Mariotti, C., Coletta, P., Maurizi, A., Sebastiani, E. (2014). Conservative Mastectomy. In: Mariotti, C. (eds) Oncologic Breast Surgery. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5438-7_5
Download citation
DOI: https://doi.org/10.1007/978-88-470-5438-7_5
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5437-0
Online ISBN: 978-88-470-5438-7
eBook Packages: MedicineMedicine (R0)