nipplesparing

Nipple-sparing, often called nipple-sparing mastectomy (NSM), is a surgical approach in which the nipple-areola complex (NAC) is preserved while removing most or all breast glandular tissue. It is typically followed by immediate breast reconstruction and is designed to maintain breast appearance and a portion of natural sensation.

Indications for nipple-sparing procedures include risk-reducing surgery for individuals at high genetic or familial risk of breast cancer (such as BRCA mutation carriers) and therapeutic mastectomy for select patients with breast cancer. Suitable candidates generally have tumors that are not involving the NAC, favorable imaging findings, and adequate NAC blood supply. Preoperative evaluation often includes imaging (such as MRI) and, in some cases, NAC biopsy to assess cancer involvement.

Technique and variations involve preserving the NAC while removing glandular tissue through incisions that spare the nipple area. Sentinel lymph node biopsy or axillary dissection may be performed as part of cancer treatment. Reconstruction is commonly performed immediately using implants or autologous tissue, and options include skin-sparing approaches in addition to nipple-sparing techniques.

Outcomes and considerations: NSM can yield superior cosmetic results and preserve the appearance of the breast, with potential for preserved nipple sensation and, in select cases, breastfeeding ability. However, there is a risk of residual breast tissue beneath the NAC, NAC necrosis, infection, seroma, or implant-flap complications. Cancer recurrence involving the NAC, while uncommon if the NAC is free of disease, remains a concern and contributes to careful patient selection and postoperative monitoring.