Nipple Sparing Mastectomy

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Nipple-sparing mastectomy (NSM):
    • Has increasingly become an acceptable choice for risk reduction in the BRCA1 and BRCA2 mutation carrier population due to a potential superior cosmetic outcome compared to skin-sparing mastectomy
  • Macromastia (C cup breast or higher):
    • Can result in malposition of the nipple and may require alternative incisions or a standard skin-sparing mastectomy approach for optimal cosmetic results
  • Grade I ptosis is not a contraindication to NSM:
    • However, ptosis of grade 2 or higher:
      • Can also result in malposition of the nipple-areolar complex (NAC)
  • Regarding future cancer risk:
    • There may be a small risk associated with leaving the NAC in situ
    • The greater risk appears to be within the at-risk breast tissue left on thicker mastectomy skin flaps rather than within the NAC itself:
      • As studies have shown the majority of cancer recurrences occur outside of the NAC:
        • Therefore, optimizing dissection technique and choosing appropriate incisions are essential to obtaining optimal oncologic outcomes with this procedure
  • A previous benign biopsy of calcifications is not a contraindication to NSM:
    • However, extensive malignant calcifications, tumors less than to 2 cm from the nipple, nipple discharge, or a rash on the nipple are contraindications to NSM
  • References:
    • Tousimis E, Haslinger M. Overview of indications for nipple sparing mastectomy. Gland Surg. 2018;7(3):288-300.
    • Manning AT, Wood C, Eaton A, Stempel M, Capko D, Pusic A, et al. Nipple-sparing mastectomy in patients with BRCA1/2 mutations and variants of uncertain significance. Br J Surg. 2015;102(11):1354-1359.
    • Yao K, Liederbach E, Tang R, Lei L, Czechura T, Sisco M, et al. Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol. 2015;22(2):370-376.
    • Moo TA, Pinchinat T, Mays S, Landers A, Christos P, Alabdulkareem H, et al. Oncologic outcomes after nipple-sparing mastectomy. Ann Surg Oncol. 2016;23(10):3221-3225
    • Jakub JW, Peled AW, Gray RJ Greenup RA, Kiluk JV, Sacchini V, et al. Oncologic safety of prophylactic nipple sparing mastectomy in a population with BRCA mutations: A multi-institutional study. JAMA Surg. 2018;153(2):123-129.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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