Precision in Preservation: Nipple-Sparing Mastectomy and Oncoplastic Optimization

As surgical oncology shifts toward a "less is more" philosophy without compromising oncologic safety, nipple-sparing mastectomy and oncoplastic techniques have moved from the periphery to the mainstream. However, selecting the right patient remains a high-stakes decision-making process.

Kathie-Ann Joseph, MD, MPH, FACS, spoke with CancerNetwork® regarding her clinical framework for identifying optimal candidates, emphasizing the critical interplay between tumor topography and margin security. From assessing the distance between the lesion and the nipple-areolar complex to leveraging multidisciplinary collaboration for tissue rearrangement, Joseph outlines how clinicians can bridge the gap between radical resection and aesthetic restoration.

Joseph is chief of Breast Surgery and co-director of the Breast Oncology Program, Rutgers Cancer Institute and Jack & Sheryl Morris Cancer Center; associate chief surgical officer for System Integration and Quality, RWJBarnabas Health; director of Breast Surgical Services, RWJBarnabas Health Southern Region; and professor of surgery, Rutgers Robert Wood Johnson Medical School.

Transcript:

Not every patient can be a candidate for it, but more patients are, as we have more data on recurrence rates and so forth. We look at the size of the tumor, the location of the tumor, and how far it is from the nipple, is another important aspect of whether or not we can do nipple sparing. If it’s right up against the nipple, I will probably not offer that patient a nipple sparing [surgery]. I’m talking about nipple sparing because we want to make sure that we have clear margins when we remove a cancer. As much as we’d like to offer it, and I want to, I want to also make sure that the patient’s going to have a safe operation, and that they don't have tumor recurrence. Those are the things that would dictate nipple sparing. We just want to make sure that we’re not leaving any tumor behind with the nipple and so as far as oncoplastic, it is about making sure that we can rearrange the tissue, make sure the patient has a normal appearing breast. I’ll sometimes bring in the plastic surgeons to help if I need it, but we have that discussion with the patient and make sure that they’re okay with it, but a lot of times I don’t even need their help.