Sparing mastectomy of the nipple areola complex

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Published: 26 Mar 2015
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Prof Paolo Veronesi – European Institute of Oncology, Milan, Italy

Prof Paolo Veronesi talks to ecancertv at the ecancer Breast Cancer Symposium in Peru about a procedure developed by the European Institute of Oncology (IEO) called ‘conservative mastectomy’ which involves breast reconstruction immediately following the mastectomy operation and aims to preserve the areola or nipple where biopsy shows this to be safe. This has a big impact on recovery and quality of life as it minimizes the emotional trauma associated with the procedure. 

The topic of my presentation was conservative mastectomy, a new technique of mastectomy plus immediate reconstruction we started to develop at the European Institute of Oncology about fifteen years ago in the year 2000.

At the time we decided to try to preserve the nipple areola complex in selected cases of mastectomies.

Nowadays mastectomies account for almost 25-30% of breast cancer surgeries and surprisingly there are more cases of mastectomy now than ten years ago.

This is due to most accurate diagnostic tools like digital mammography, like ultrasound, like magnetic resonance.

We discovered a higher number of multi-centric or multi-focussed cancers or invasive cancers with extensive intraductal component associated, so patients who, even in the case of early diagnosis, in cases of cancer for small cancers, but who need, anyway, a mastectomy.

So we tried to do this kind of mastectomy and the results are very good.

We do this operation in co-operation with plastic surgeons and usually the operation starts like a quadrantectomy with a radial incision on the skin.

We sometimes remove a portion of skin over the tumour, exactly like a quadrantectomy, but then we remove all the gland and during the operation we do a biopsy of the retroareolar tissue and send it for further section to check the absence of proliferative cancer cells in the nipple.

If this exam is negative we can save the nipple, remove all the breast tissue and with the sentinel node biopsy or axillary excision, depending case by case, and complete the operation with immediate reconstruction with submuscular prostheses.

These operations allow us to obtain very good cosmetic results and the patients are very, very satisfied because they avoid the trauma of mutilation, of absence of the nipple.

Very often they have a cosmetic result better than before surgery because, with prostheses and sometimes contralateral augmentation or reduction, depending on the case, they can obtain very, very good cosmetic results.

This is very important for the psychology of the women.

This technique is not feasible in all cases.

We have to exclude cases with nipple areola involvement by the cancer; of course Paget's disease; inflammatory cancer or too big breasts, even if in these cases sometimes we can combine nipple sparing with a skin reducing mastectomy with the plastic surgeon, we can obtain very good results.

We have to discuss case by case patients with a previous radiotherapy on the breast.

Very often we have to do a mastectomy for recurrence after breast conserving surgery in radiotherapy so in these cases the vascularisation of the skin and of the nipple could be difficult so we have to decide case by case if we try to preserve the nipple.

But in most cases we can do this technique.

I enjoyed very much this symposium, the high level of scientific presentation and here in Peru I saw the data there by the epidemiologists and there are many cancers diagnosed as advanced cancers, 75%, the contrary as in Western countries in which 75% are early diagnosis nowadays.

So there are many things to do, a lot of things to do in terms of prevention, screening.

But the study is a good way to reach this goal.

So I wish to thank ecancer for having organised this beautiful congress and I think that the goal of ecancer Latin America is a very good thing because it is a place in which we have to give our oncological culture.

This is a good means because it’s free for everybody and it’s updated every day by the people who are in it. So it’s a good experience.