The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy

Amy Rivere, Pallavi Archana Kumbla, Vicki Klimberg

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The total skin-sparing mastectomy has become routinely offered to patients in our practice as the mastectomy has evolved from the radical, to modified radical, to simple mastectomy, then skin-sparing, and now total skin-sparing or nipple skin-sparing mastectomy. The current literature suggests that the total skin-sparing mastectomy is an oncologically safe procedure for patients, excluding those with involvement of the nipple-areola complex and those with skin involvement or inflammatory breast cancer. Throughout our experience with the total skin-sparing mastectomy, our techniques and inclusion criteria for the procedure have evolved as more data has become available. We begin with our pre-incision injections for routine performance of the axillary reverse mapping procedure. This technique is used for sentinel lymph node biopsies as well as axillary lymph node dissections to minimize lymphedema of the ipsilateral upper extremity. Although our initial experience with the total skin-sparing mastectomy was mostly via an inframammary incision, we have transitioned to the vertical infra-areolar approach to the nipple-sparing mastectomy in most cases. This incision provides maximal preservation of the blood supply to the nipple and creates a superior cosmetic outcome to most other incisions as it sets the nipples in correct and matching position. However, we do recognize that there are exceptions, and we do utilize various other incisions when necessary.

Original languageEnglish (US)
Title of host publicationOperative Approaches to Nipple-Sparing Mastectomy
Subtitle of host publicationIndications, Techniques, and Outcomes
PublisherSpringer International Publishing
Pages53-65
Number of pages13
ISBN (Electronic)9783319432595
ISBN (Print)9783319432571
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Nipples
Mastectomy
Skin
Blood Preservation
Inflammatory Breast Neoplasms
Simple Mastectomy
Sentinel Lymph Node Biopsy
Lymphedema
Lymph Node Excision
Upper Extremity
Cosmetics
Injections

Keywords

  • Axillary reverse mapping
  • Botulinum toxin
  • Dilation technique
  • Mastectomy
  • Nipple-sparing mastectomy
  • One-stage breast reconstruction
  • Sentinel lymph node biopsy
  • Skin-sparing mastectomy
  • Total skin-sparing mastectomy
  • Two-stage breast reconstruction
  • Vertical infra-areolar incision

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rivere, A., Kumbla, P. A., & Klimberg, V. (2016). The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy. In Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, and Outcomes (pp. 53-65). Springer International Publishing. https://doi.org/10.1007/978-3-319-43259-5_6

The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy. / Rivere, Amy; Kumbla, Pallavi Archana; Klimberg, Vicki.

Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, and Outcomes. Springer International Publishing, 2016. p. 53-65.

Research output: Chapter in Book/Report/Conference proceedingChapter

Rivere, A, Kumbla, PA & Klimberg, V 2016, The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy. in Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, and Outcomes. Springer International Publishing, pp. 53-65. https://doi.org/10.1007/978-3-319-43259-5_6
Rivere A, Kumbla PA, Klimberg V. The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy. In Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, and Outcomes. Springer International Publishing. 2016. p. 53-65 https://doi.org/10.1007/978-3-319-43259-5_6
Rivere, Amy ; Kumbla, Pallavi Archana ; Klimberg, Vicki. / The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy. Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, and Outcomes. Springer International Publishing, 2016. pp. 53-65
@inbook{505b28bb6334460f9948d7ed3a4e5b53,
title = "The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy",
abstract = "The total skin-sparing mastectomy has become routinely offered to patients in our practice as the mastectomy has evolved from the radical, to modified radical, to simple mastectomy, then skin-sparing, and now total skin-sparing or nipple skin-sparing mastectomy. The current literature suggests that the total skin-sparing mastectomy is an oncologically safe procedure for patients, excluding those with involvement of the nipple-areola complex and those with skin involvement or inflammatory breast cancer. Throughout our experience with the total skin-sparing mastectomy, our techniques and inclusion criteria for the procedure have evolved as more data has become available. We begin with our pre-incision injections for routine performance of the axillary reverse mapping procedure. This technique is used for sentinel lymph node biopsies as well as axillary lymph node dissections to minimize lymphedema of the ipsilateral upper extremity. Although our initial experience with the total skin-sparing mastectomy was mostly via an inframammary incision, we have transitioned to the vertical infra-areolar approach to the nipple-sparing mastectomy in most cases. This incision provides maximal preservation of the blood supply to the nipple and creates a superior cosmetic outcome to most other incisions as it sets the nipples in correct and matching position. However, we do recognize that there are exceptions, and we do utilize various other incisions when necessary.",
keywords = "Axillary reverse mapping, Botulinum toxin, Dilation technique, Mastectomy, Nipple-sparing mastectomy, One-stage breast reconstruction, Sentinel lymph node biopsy, Skin-sparing mastectomy, Total skin-sparing mastectomy, Two-stage breast reconstruction, Vertical infra-areolar incision",
author = "Amy Rivere and Kumbla, {Pallavi Archana} and Vicki Klimberg",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/978-3-319-43259-5_6",
language = "English (US)",
isbn = "9783319432571",
pages = "53--65",
booktitle = "Operative Approaches to Nipple-Sparing Mastectomy",
publisher = "Springer International Publishing",

}

TY - CHAP

T1 - The vertical infra-areolar approach to nipple skin-sparing or total skin-sparing mastectomy

AU - Rivere, Amy

AU - Kumbla, Pallavi Archana

AU - Klimberg, Vicki

PY - 2016/1/1

Y1 - 2016/1/1

N2 - The total skin-sparing mastectomy has become routinely offered to patients in our practice as the mastectomy has evolved from the radical, to modified radical, to simple mastectomy, then skin-sparing, and now total skin-sparing or nipple skin-sparing mastectomy. The current literature suggests that the total skin-sparing mastectomy is an oncologically safe procedure for patients, excluding those with involvement of the nipple-areola complex and those with skin involvement or inflammatory breast cancer. Throughout our experience with the total skin-sparing mastectomy, our techniques and inclusion criteria for the procedure have evolved as more data has become available. We begin with our pre-incision injections for routine performance of the axillary reverse mapping procedure. This technique is used for sentinel lymph node biopsies as well as axillary lymph node dissections to minimize lymphedema of the ipsilateral upper extremity. Although our initial experience with the total skin-sparing mastectomy was mostly via an inframammary incision, we have transitioned to the vertical infra-areolar approach to the nipple-sparing mastectomy in most cases. This incision provides maximal preservation of the blood supply to the nipple and creates a superior cosmetic outcome to most other incisions as it sets the nipples in correct and matching position. However, we do recognize that there are exceptions, and we do utilize various other incisions when necessary.

AB - The total skin-sparing mastectomy has become routinely offered to patients in our practice as the mastectomy has evolved from the radical, to modified radical, to simple mastectomy, then skin-sparing, and now total skin-sparing or nipple skin-sparing mastectomy. The current literature suggests that the total skin-sparing mastectomy is an oncologically safe procedure for patients, excluding those with involvement of the nipple-areola complex and those with skin involvement or inflammatory breast cancer. Throughout our experience with the total skin-sparing mastectomy, our techniques and inclusion criteria for the procedure have evolved as more data has become available. We begin with our pre-incision injections for routine performance of the axillary reverse mapping procedure. This technique is used for sentinel lymph node biopsies as well as axillary lymph node dissections to minimize lymphedema of the ipsilateral upper extremity. Although our initial experience with the total skin-sparing mastectomy was mostly via an inframammary incision, we have transitioned to the vertical infra-areolar approach to the nipple-sparing mastectomy in most cases. This incision provides maximal preservation of the blood supply to the nipple and creates a superior cosmetic outcome to most other incisions as it sets the nipples in correct and matching position. However, we do recognize that there are exceptions, and we do utilize various other incisions when necessary.

KW - Axillary reverse mapping

KW - Botulinum toxin

KW - Dilation technique

KW - Mastectomy

KW - Nipple-sparing mastectomy

KW - One-stage breast reconstruction

KW - Sentinel lymph node biopsy

KW - Skin-sparing mastectomy

KW - Total skin-sparing mastectomy

KW - Two-stage breast reconstruction

KW - Vertical infra-areolar incision

UR - http://www.scopus.com/inward/record.url?scp=85029109852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029109852&partnerID=8YFLogxK

U2 - 10.1007/978-3-319-43259-5_6

DO - 10.1007/978-3-319-43259-5_6

M3 - Chapter

AN - SCOPUS:85029109852

SN - 9783319432571

SP - 53

EP - 65

BT - Operative Approaches to Nipple-Sparing Mastectomy

PB - Springer International Publishing

ER -