Nipple-sparing mastectomy in breast cancer: a viable option?

Background: In women with breast cancer for whom breast-conserving therapy (BCT) is not the best option, a nipple and areola complex-(NAC) sparing mas tectomy with immediate reconstruction has been proposed as a good and safe alternative to conventional, more radical mastectomy. Surgeons hesitate to perform this operation for fear of recurrence of tumour in the NAC due to u ndetected nipple involvement (NI) of the tumour. In order to determine whet her a NAC-sparing mastectomy is a viable option, the frequency and predicti ve factors of NI by the tumour were studied in the literature. Methods: A literature survey was performed by searching the Medline databas e. Other references were derived from the material perused. Results and Conclusions: NI is found in up to 58% of mastectomy specimens a nd correlates with tumour size, tumour-areola or tumour-nipple distance, po sitive lymph nodes and clinical suspicion. Best candidates for NAC-sparing mastectomy are patients with a small tumour (TI) at a large distance (>4-5 cm) from the nipple. However, in these patients BCT has excellent results w ith low complications and recurrence rates. Considering the incidence of NI in larger tumours (T2 average 33%, T3 average > 50%) a NAC-sparing mastect omy may carry an unacceptable high risk for local relapse and should theref ore not be advocated. (C) 2001 Harcourt Publishers Ltd.