Nipple-Sparing Mastectomy

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Nipple-sparing mastectomy:
    • Has been a highly debated topic since first described by Hinton et al in 1984
  • There is consensus regarding some contraindications to nipple-sparing mastectomies, such as:
    • Direct involvement of the nipple or areola by tumor
  • However, many relative contraindications, such as:
    • Tumor size greater than 2 cm
    • Tumor location within 1 cm to 2 cm of the nipple-areolar complex:
      • Are still debated
  • Additional relative contraindication considerations are:
    • Perioperative smoking (or smoking within 4 weeks of surgery):
      • Which increases the risk of complication significantly:
        • As much as 2 to 10 times the risk, depending on the study
    • Obesity (BMI of ≥30):
      • Which doubles the risk
    • Older women:
      • Have not shown to have higher rates of nipple or skin necrosis in a large single institutional study
  • Despite early concerns:
    • There is no decreased survival by maintaining the nipple-areolar complex with mastectomy procedures, including in pathologic mutation carriers
  • Nipple-sparing mastectomies:
    • Are almost always performed in conjunction with some form of immediate reconstruction
  • The type of planned reconstruction influences the incision choice and outcomes:
    • Salibian et al. looked at immediate microvascular autologous reconstructions:
      • He found that vertical incisions had only a 5.8% rate of ischemic complications:
        • Whereas inframammary incisions had a 25% rate and lateral radial a 7.8% rate of ischemic complications
    • This has been shown in systematic reviews as well
  • References:
    • Galimberti V, Vicini E, Corso G, et al. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast. 2017;34 Suppl 1(Suppl 1):S82-S84. doi: 10.1016/j.breast.2017.06.034
    • McCarthy CM, Mehrara BJ, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg. 2008;121(6):1886-1892. doi: 10.1097/PRS.0b013e31817151c4
    • Parmeshwar N, Dugan CL, Barnes LL, et al. Nipple-sparing mastectomies in patients over the age of 60 years: factors associated with surgical outcomes. Ann Surg Oncol. 2023;30(13):8428-8435. doi: 10.1245/s10434-023-14278-6
    • Metere A, Fabiani E, Lonardo MT, Giannotti D, Pace D, Giacomelli L. Nipple-sparing mastectomy long-term outcomes: early and late complications. Medicina (Kaunas). 2020;56(4):166. doi: 10.3390/medicina56040166
      Salibian AA, Bekisz JM, Frey JD, et al. Comparing incision choices in immediate microvascular breast reconstruction after nipple-sparing mastectomy: unique considerations to optimize outcomes. Plast Reconstr Surg. 2021;148(6):1173-1185. doi: 10.1097/PRS.0000000000008282
    • Chicco M, Ahmadi AR, Cheng H-T. Systematic review and meta-analysis of complications following mastectomy and prosthetic reconstruction in patients with and without prior breast augmentation. Aesthet Surg J. 2021;41(7):NP763-NP770. doi: 10.1093/asj/sjab028
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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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