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Research conducted at The Cleveland Clinic is challenging the long-held
belief that nipple-sparing surgery is not a reasonable option for women
undergoing total breast removal. Clinic researchers concluded that carefully
screened patients may have the option of undergoing a nipple-sparing mastectomy,
which more closely preserves the body’s natural appearance.
Joseph P. Crowe, M.D., director of the Clinic’s Breast Center, developed
the nipple-sparing procedure and led the study of 54 nipple-sparing mastectomy
procedures involving 44 Clinic patients who were carefully screened and deemed
eligible for the procedure. Results for the study, conducted between September
2001 and June 2003, appear in the Feb. 9 issue of Archives of Surgery.
"For women who undergo mastectomies and opt for breast reconstruction,
the nipple-sparing mastectomy presents an alternative of considerable cosmetic
and psychological benefit," Dr. Crowe said. "The key is to carefully
screen patients for their eligibility.
"As a surgeon, I am pleased with the results of nipple-sparing
mastectomies completed at the Clinic," said Dr. Crowe. "But the
satisfaction expressed by the women who have undergone the procedure speaks
volumes about the difference it can make in their lives."
Viable option
Results of the study indicate that in 45 of 48 surgeries, the nipple-areola
complex remained viable after surgery. Three of the procedures resulted in the
partial loss of the nipple-areola complex, possibly because blood flow to the
area was compromised, said Dr. Crowe. For six planned procedures, the
nipple-areola complex was removed during surgery after cancer cells were
identified in the nipple tissue.
"Overall, these results indicate that nipple-sparing mastectomies are a
viable option for women who have been carefully screened and identified as
candidates to undergo the procedure," said Dr. Crowe.
Patients in The Cleveland Clinic study ranged in age from 29 to 72, with a
mean age of 43. Thirty procedures (56 percent) were performed for infiltrating
breast cancer with tumors measuring 0.1 to 3.5 centimeters. Seven procedures (13
percent) were for ductal carcinoma in-situ (cancer contained in the breast
ducts), and 17 procedures (31 percent) were performed to prevent development of
cancer in high-risk patients.
Clinic helps pioneer procedure
In a nipple-sparing mastectomy, the breast tissue is removed through small
incisions while the skin, nipple and areola are left in place. Pre-operative
screening for all patients includes clinical breast examination, a thorough
review of mammograms, informed patient consent and a breast reconstruction
evaluation by a plastic surgeon. For patients with breast cancer, evaluation of
tumor size and location within the breast are also considered. During the
surgery, the tissue under the nipple is analyzed to determine if it contains any
cancer cells.
The Cleveland Clinic was one of the first hospitals in the country to offer
the procedure, an extension of the skin-sparing mastectomy. Conventional wisdom
in the medical field has been reluctant to embrace preservation of the
nipple-areola complex in women undergoing total mastectomies, however, because
of concerns that cancer cells could be left behind.
All nipple-sparing mastectomies at The Cleveland Clinic are performed by Dr.
Crowe and fellow surgical oncologist, Julian Kim, M.D. They work in conjunction
with plastic surgeons Randall Yetman, M.D., and Jillian Banbury, M.D.
Women who may benefit most from nipple-sparing mastectomies include those who
undergo breast removal as part of their cancer treatment and those who choose to
have mastectomies as a preventive measure because they are at high risk of
developing breast cancer.
Nipple-sparing mastectomies are not appropriate for patients whose tumors are
large, close to the nipple or centrally located. Patients must also be suitable
candidates for immediate breast reconstruction. Although the cosmetic benefits
of this procedure are remarkable, sensitivity of the nipple is diminished or
absent for most patients.
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