SPECIFIC CONTRAINDICATIONS TO BREAST RECONSTRUCTION

Abstract

Despite these intuitive concerns about nipple-sparing mastectomy (NSM) for breast cancer, several groups have explored this approach for smaller peripheral breast cancers situated more than 2 cm from the nipple-areola complex. Enthusiasm for these approaches has been spurred on by reports of the oncological safety of SSM. Pioneering work in this field has been carried out at the European Institute of Oncology in Milan. Between 2002 and 2007, 1060 patients underwent NSM for invasive ductal carcinoma (75%) or ductal carcinoma in situ (DCIS) (25%) lying at least 2 cm away from the nipple-areola complex. Frozen section examination was performed and 8% of patients had positive margins deep to the nipple-areola complex. Eighty percent of patients received intraoperative radiotherapy (IORT) in which the nipple-areola complex was irradiated intraoperatively with a single dose of 21 Gy. There was a finite rate of partial (5.5%) and total (3.5%) nipple necrosis. Interim analysis at 20-month follow-up revealed a very low rate of local recurrence (1.4%) and none of the cases of local relapse involved the nipple-areola complex (43). The very low rates of local recurrence with IORT prompts the question of whether acceptable rates of local recurrence for NSM could be achieved without the use of radiotherapy. The Milan group are currently reviewing their IORT strategy as local recurrence remains at only 1.4% at three-year follow-up (44). In the meantime, other groups have undertaken NSM without irradiation of the nipple-areola complex.