Dr. Morrow on Patient Selection for Nipple Sparing Mastectomy

Author(s):

Monica Morrow, MD, discusses the factors that impact the decision to use nipple sparing mastectomy versus conventional mastectomy in patients with breast cancer. The decision to use a nipple sparing approach in patients is dependent on 2 considerations. These relate to the cancer as well as cosmetic appearance of the breast.

Monica Morrow, MD, chief of Breast Service at Memorial Sloan Kettering Cancer Center, discusses the factors that impact the decision to use nipple sparing mastectomy versus conventional mastectomy in patients with breast cancer. The decision to use a nipple sparing approach in patients is dependent on 2 considerations. These relate to the cancer as well as cosmetic appearance of the breast.

Because there is a higher likelihood of nipple involvement in patients with larger cancers closer to the nipple, the ideal candidate for nipple sparing mastectomy would be a patients with a small peripheral breast cancer. Studies have also shown that for those patients where HER2 is over expressed, they are more likely to have nipple involvement because of a higher association to ductal carcinoma in situ (DCIS), says Morrow.

In terms of cosmetic appearance, the decision to move forward with a nipple sparing procedure versus conventional approaches depend on the placement of the nipple. For example, those with larger breasts may be poorer candidates, says Morrow, compared with patients who have smaller breasts.