Update on the indications for nipple-sparing mastectomy.

There is renewed interest in the use of nipple-sparing mastectomy (NSM), which combines skin-sparing mastectomy with preservation of the nipple-areola complex. NSM may be an oncologically safe treatment in a subgroup of patients who are candidates for breast-conserving surgery but still prefer to undergo mastectomy. A combination of newer techniques and good coordination between plastic and oncologic surgeons can achieve excellent cosmetic results and a low incidence of postoperative complications. However, major concerns about NSM include the persistent risk for breast cancer development when it is used for prophylaxis as well as the potential failure of local control when it is used for treatment. The reported experience with these newer techniques lacks the power to generate a consensus for its indications because of limited reported series with small populations. Although the current role of NSM seems to be more defined as a prophylactic procedure in high-risk patients, prospective studies and reports are needed to better define its indications.