Cleveland Clinic Study Finds Nipple-Sparing Mastectomy is a Reasonable Option for Carefully Screened Patients

Cleveland Clinic Study Finds Nipple-Sparing Mastectomy is a Reasonable Option for Carefully Screened Patients
Monday February 9, 4:00 pm ET
Research Results Appear in Feb. 9 issue of Archives of Surgery

CLEVELAND, Feb. 9 /PRNewswire/ -- 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. Instead, the study concludes 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 Breast Center at The Cleveland Clinic, 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," Dr. Crowe continued. "But the satisfaction expressed by the women who have undergone the procedure speaks volumes about the difference it can make in their lives."

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, Dr. Crowe said. 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," Dr. Crowe said.

Patients in The Cleveland Clinic study ranged from 29 to 72 years old with the mean age being 43 years. 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.

In a nipple-sparing mastectomy, the breast tissue is removed through tiny 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 has been 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.

The Cleveland Clinic Foundation, located in Cleveland, Ohio, is a not-for- profit multispecialty academic medical center that integrates clinical and hospital care with research and education. The Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names The Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. In 2003, The Cleveland Clinic is ranked fifth overall. Approximately 1,200 full-time salaried physicians at The Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2002, there were nearly 2.5 million outpatient visits to The Cleveland Clinic and more than 52,000 hospital admissions. Patients came for treatment from every state and from more than 90 countries. The Cleveland Clinic website address is www.clevelandclinic.org .

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Source: The Cleveland Clinic Foundation

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