The Nipple-Areola Preserving Mastectomy: A Multistage Procedure Aiming to Improve Reconstructive Outcomes following Mastectomy

Abstract

Ischemia of the nipple-areola complex (NAC) and periareolar tissue is commonly seen following tissue-preserving mastectomies for small invasive and noninvasive cancers. The nipple-areola preserving mastectomy is a multistage procedure in which the NAC and central mastectomy flap tissue is surgically delayed to improve the survivability in patients undergoing mastectomies followed by reconstruction.

Methods: We conducted a retrospective chart review of 20 patients undergoing the 2-stage nipple-areola preserving mastectomy: the first stage comprised undermining the NAC and raising the breast skin flaps, with placement of a silicone sheet in the dissected pocket. The second stage followed 2-3 weeks after the NAC delay, with patients undergoing nipple-sparing mastectomies.

Results: Mean age was 46.2 years (range, 23-59 years). Indications included breast cancer in 18 patients and BRCA gene mutation prophylaxis in 2 patients. None were actively smoking. Mean time between delay of flaps and breast reconstructions was 16 days (range, 10-35 days). One patient underwent bilateral nipple resection at the time of mastectomies due to a subareolar nipple biopsy positive for ductal carcinoma in situ. One patient underwent left nipple excision after a skin nipple biopsy was positive for metaplasia. No signs of NAC vascular compromise were observed in any of the cases.

Conclusions: Our 2-stage approach benefits patients undergoing nipple-sparing mastectomy, especially those at high-risk, by safely increasing survivability of the native breast skin envelope and NAC, while improving oncologic outcomes by identification of subareolar malignancies and sentinel node status before mastectomy and reconstruction.

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Figures

Fig. 1.

Postoperative view of the patient 5 days following bilateral delay of the flaps.

Fig. 2.

Both breasts revealed no signs of vascular compromise during inspection.

Fig. 3.

Postoperative results 8 months after bilateral reconstruction with the DIEP flap.

Fig. 4.

No complications developed postoperatively, achieving total satisfaction.

Fig. 5.

Appearance of the breasts after 6 days following bilateral flap delay.

Fig. 6.

The NAC in both breasts without any signs of necrosis.

Fig. 7.

Photographs taken after 6 months. The patient underwent bilateral reconstruction with the DIEP flap.

Fig. 8.

Her postoperative course was uneventful, with both flaps healing nicely.