Surgical and social perspectives on nipple sparing mastectomy

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Published: 24 Mar 2017
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Dr Viviana Galimberti - European Institute of Oncology, Milan, Italy

Dr Galimberti speaks with ecancer at the 2017 St. Gallen International Breast Cancer Conference about nipple sparing mastectomy, a surgical technique which aims to maintain the nipple and areola in radical mastectomy patients.

She describes the improved patient perceptions post-surgery, and that the technique is also applicable in risk-reducing mastectomy.

I’m talking about nipple sparing mastectomy, that is a new conservative mastectomy that is in line. It’s the logical development of a conservative treatment before with conserving of the breast and then with the development of sentinel node biopsy allowing axillary section in many patients. Now, more recently, there is a development of this new technique. Nipple sparing mastectomy is a mastectomy, a radical mastectomy, because all the gland is removed but you leave all the skin and particularly the nipple areolar complex.

Many studies have demonstrated the safety of this, the oncological safety of this procedure. It can be applied also for risk reducing in BRCA mutation patients, BRCA carriers, and appear in a better aesthetic outcome for a patient, more satisfaction for the patient because the presence of a nipple leaves the breast like originally. So there are many studies that have demonstrated that the social wellbeing is higher in these patients than for patients that the nipple areolar complex is not preserved.

How widely is this procedure used?

The selection of patients must be important because we can do this type of mastectomy for multicentric tumours or other type of tumours that require mastectomy but without involvement of the nipple areolar complex, without clinical and imaging involving of the nipple areolar complex. Particularly important is that the frozen section that we perform during the intervention should be negative. In this manner you can preserve the nipple areolar complex and the reconstruction is the same for other types of mastectomy – you can use heterologous flaps or not.