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Annals of Surgical Oncology 9:165-168 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Analysis of Nipple/Areolar Involvement With Mastectomy: Can the Areola Be Preserved?

Rache M. Simmons, MD, FACS, Meghan Brennan, RN, ONP, MSN, OCN, Paul Christos, MPH, MS, Valencia King, BS and Michael Osborne, MD FACS

From the Departments of Surgery (RMS, MO) and Public Health (PC), Weill Medical College of Cornell University (VK); the New York Presbyterian Hospital (RMS, MO); and the Strang Weill Cornell Breast Center (MB), New York, New York.

Correspondence: Address correspondence and reprint requests to: Rache M. Simmons, MD, FACS, 425 E. 61st St., 8th Floor, New York, NY 10021; Fax: 212-821-0832; E-mail: rms2002{at}med.cornell.edu

Background: Skin-sparing mastectomy (SSM), which involves the resection of the nipple/areolar complex with the breast parenchyma, improves the aesthetic outcome for breast cancer patients. Most patients undergoing SSM desire reconstruction of the nipple/areolar complex for symmetry. These data explore the possibility of preserving the areola in selected mastectomy patients.

Methods: A retrospective analysis of 217 mastectomy patients was conducted to determine the frequency of malignant nipple and/or areola involvement. The association between nipple and/or areola involvement and prognostic factors, including tumor size, stage, nuclear grade, axillary nodal status, and tumor location, was evaluated.

Results: The overall frequency of malignant nipple involvement was 23 of 217 (10.6%). In a subgroup of patients with tumors <2 cm, peripheral tumors, and with two positive nodes or less, the incidence of nipple involvement was 6.7%. When the nipple and areolar involvement were analyzed separately, only 2 of 217 patients had involvement of the areola (0.9%). All patients with areolar involvement had stage 3 breast cancer and were located centrally in the breast.

Conclusions: We conclude from these data that nipple preservation is not a reasonable option for mastectomy patients. However, preservation of the areola with mastectomy in selected patients warrants further study.

Key Words: Areola preservation • Skin-sparing mastectomy • Nipple involvement • Breast reconstruction




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