Abstract
Randomized trials, such as the National Surgical Adjuvant Breast and Bowel Project B-04 and B-06 clinical trials, provided a foundation for a minimally invasive approach to the surgical management of early breast cancers. Data from these trials resulted in women being offered breast conservation surgery rather than mastectomy. However, there will always be women who are not candidates for conservation surgery or who simply prefer mastectomy. For such patients, the surgical approach to mastectomy has shifted from the disfiguring radical mastectomy of old to skin-sparing mastectomy. Out of the skin-sparing technique evolved the subcutaneous mastectomy, described by Freeman in 1962. Today, the nipple-sparing mastectomy (NSM), as subcutaneous mastectomy is now called, offers an even better cosmetic outcome and has garnered much attention as mastectomy rates overall continue to increase in many parts of the United States. However, the question remains: Does NSM adequately accomplish the goal of mastectomy, which is to remove the entire mammary gland for maximum therapeutic benefit for those with cancer or prophylaxis for those at risk?
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