News: Mastectomy procedure succeeds in preserving nipple

Total skin-sparing mastectomy (TSSM) is a reasonable option for some women with breast cancer and those undergoing prophylactic mastectomy who wish to preserve the natural appearance of their nipple, according to an article published in the January issue of the Archives of Surgery.

Akushla Wijayanayagam, MD, of the University of California San Francisco, and colleagues describe the results of TSSM procedures performed on 64 breasts in 43 women. Contraindications for the surgery included mammography or MRI evidence of carcinoma within 2 cm of the nipple. Mastectomies were performed using one of five types of incisions.

The nipple-areola skin completely survived in 80% of cases. The radial incision-across part of the areola-offered the best chance of preserving healthy areola and nipple skin (97%). The researchers abandoned the nipple-areola complex (NAC)-crossing incision, as the NAC only survived in two of the 11 procedures in which it was used. The authors note that NAC skin preservation could add a 1% to 2% risk of cancer recurrence.

Wijayanayagam A , Kumar AS, Foster RD, et al. Optimizing the total skin-sparing mastectomy. Arch Surg. 2008;143:38-45.