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Terminal Duct Lobular Units are Scarce in the Nipple: Implications for Prophylactic Nipple-Sparing Mastectomy

Terminal Duct Lobular Units in the Nipple

¹ Tulane University Department of Surgery and Omega Hospital, 2525 Severn Ave, New Orleans, LA, USA
² Department of Pathology, Ochsner Health System, New Orleans, LA, USA

Correspondence: Address correspondence and reprint requests to: Alan J. Stolier, MD FACS; E-mail: astolier{at}tulane.edu

Background: The use of nipple-sparing mastectomy (NSM) for both breast cancer treatment and risk reduction is increasing. There is no randomized data comparing nipple-sparing mastectomy with standard mastectomy techniques. There is evidence to suggest that ductal and lobular breast cancer arises in the terminal duct/lobular unit (TDLU). This study was undertaken to determine whether TDLUs exist in the nipple and if so, to what extent.

Methods: At the time of mastectomy the nipple papilla was excised and submitted for separate pathological examination. The presence or absence of TDLUs was noted.

Results: Thirty-two nipples were studied in 22 patients. There were no TDLUs in 29 specimens. Three of 32 nipple specimens were found to contain TDLUs. The three nipples contain one, two, and three TDLUs respectively. All TDLUs were found at the base of the nipple, with none located near the tip.

Conclusions: The infrequent occurrence of TDLUs in the nipple papilla supports the use of NSM for risk reduction surgery, including for those women with BRCA1/2 mutations.

Key Words: Prophylactic mastectomy • BRCA1/2 • Breast anatomy • Breast cancer