Total skin-sparing mastectomy (TSSM) is a reasonable option for some women with breast cancer and those undergoing prophylactic mastectomy who wish to preserve the natural appearance of their nipple, according to an article published in a recent issue of the Archives of Surgery.

Akushla Wijayanayagam, MD, of the University of California, San Francisco, and colleagues describe the results of TSSM procedures performed on 64 breasts in 43 women.

Contraindications for the surgery included mammography or MRI evidence of carcinoma within 2 cm of the nipple. Mastectomies were performed using one of five types of incisions.

The nipple-areola skin completely survived in 80% of cases. The radial incision—across part of the areola—offered the best chance of preserving healthy areola and nipple skin (97%).

The researchers abandoned the nipple-areola complex (NAC)-crossing incision, as the NAC survived only in two of the 11 procedures in which it was used.

The authors note that NAC skin preservation could add a 1% to 2% risk of cancer recurrence.

"Prophylactic mastectomy reduces the incidence of breast cancer in BRCA1 and BRCA2 mutation carriers," the authors write. "As more young women discover that they are at profound risk for developing breast cancer, more acceptable prophylactic surgical and reconstructive techniques need to be identified until other preventive alternatives are found. We believe that TSSM is one such technique because it preserves the entire skin envelope of the breast, resulting in a more natural shape."

[Source: Contemporary OB/GYN]