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

Amy Rivere, Pallavi Archana Kumbla, V. Suzanne Klimberg

Research output: Chapter in Book/Report/Conference proceedingChapter


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
Number of pages13
ISBN (Electronic)9783319432595
ISBN (Print)9783319432571
StatePublished - Jan 1 2016
Externally publishedYes


  • 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

  • General Medicine


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