Using intraoperative laser angiography to safeguard nipple perfusion in nipple-sparing mastectomies

The superior cosmetic results of nipple-sparing mastectomies (NSM) account for the steady increase in use of these operations. Cancer recurrences involving the nipple-areolar complex (NAC) have been reassuringly low. Wang et al. reviewed 981 cases of total skin-sparing mastectomy (TSSM) and immediate breast reconstruction, reporting an overall 5-year locoregional recurrence of 3% and no recurrences in the NAC (1). Similarly, others have reported equally low rates of NAC recurrences, less than 1%, thus counterbalancing some of the high rates of occult involvement of the nipple with tumor as discussed below (2-5). The oncologic safety of this procedure is further demonstrated in BRCA-positive patients who are at higher risk for developing breast cancer and in patients after neoadjuvant chemotherapy (6)