Surgery · Breast (Benign, Carcinoma Breast, Staging, Treatment)

In nipple-sparing mastectomy with immediate implant-based reconstruction, which factor is the STRONGEST contraindication to nipple preservation?

  • A Tumor located in the upper outer quadrant
  • B Subareolar tumor location or nipple involvement on imaging ✓
  • C Grade 2 invasive ductal carcinoma
  • D BRCA1 carrier undergoing risk-reduction mastectomy
Correct answer: B. Subareolar tumor location or nipple involvement on imaging

Explanation

Subareolar tumor location or evidence of nipple-areola complex involvement on imaging (nipple retraction, skin changes, MRI enhancement within 2 cm of nipple) are the strongest contraindications to nipple-sparing mastectomy because the risk of residual cancer in the retained nipple-areola complex is unacceptably high. Intraoperative frozen section of the nipple base is routinely performed; if positive, the nipple must be excised. BRCA1 carriers undergoing risk-reduction mastectomy are not contraindicated from nipple sparing if the genetic risk itself is the indication, as the nipple carries no known disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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