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Anew study suggests that nipple-sparing mastectomy is also a viable surgical option for women who choose to have their breasts removed because of their increased risk of developing the disease. For both groups of women, the surgery offers a chance for a more natural looking and normal feeling reconstructed breast as compared to other forms of mastectomy.


Nipple-sparing mastectomy (NSM) involves the removal of the breast tissue while keeping intact the breast skin and nipple areola complex; the breast is usually reconstructed immediately.


A long-standing concern with this type of surgery has been that cancer cells might be left under the nipple, posing a threat over time. To examine the effectiveness of the nipple-sparing procedure, surgeons cat Georgetown University Hospital conducted a review of patient records for all women receiving the surgery there between 1989 and 2010 including surgeries to either prevent or treat breast cancer.


The results are published in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons.


"Our findings were reassuring. Of the 162 surgeries performed, we found no cancer recurrences and no new cancers in those receiving NSM," said Scott Spear, MD, Professor of Plastic Surgery at Georgetown University Medical Center and Chairman of the Department of Plastic Surgery at Georgetown University Hospital.


"The nipple-sparing technique, though, is not appropriate for every patient, depending upon their anatomy and type of breast pathology," he cautioned. "Careful selection of the right patient for NSM is an important element of success."


Some patients who received NSM at Georgetown had early-stage cancer or DCIS.


Also on the team, Georgetown breast cancer surgeon Shawna C. Willey, MD, Chief of Breast Cancer Surgery, said that the first priority always is to treat or prevent the cancer. "We need to be able to offer women options that they know will successfully treat or prevent their cancer while at the same time, preserve their quality of life, whether it be in their appearance or psychologically. Nipple-sparing mastectomy goes a long way toward reaching that goal."


One step credited for why cancers didn't develop later is that the biopsies were done on the tissue that remained under the nipple area after the NSM. If abnormal cells in this tissue were identified, as it was in four cases reviewed, either the nipple or entire nipple areola complex later were removed, Dr. Willey explained.


A second concern for this kind of surgery is that the nipple areola complex (NAC) might not receive enough blood after the tissue and blood vessels below it are removed, causing necrosis or tissue death. In the study, the records showed that three NACs became necrotic and required removal. Four other NACs had partial necrosis requiring surgery, though the nipple and the majority of the areola was spared.


"What we've learned from this review is that our established procedures and patient-selection protocol lead to favorable results," Dr. Spear said. "As more data become available, I think we'll see nipple-sparing mastectomy play a larger role, particularly in the prevention setting."