During a nipple-sparing mastectomy for BRCA1 mutation carrier (prophylactic), the surgeon performs frozen section of the retroareolar tissue. Which histological finding would mandate nipple removal?

• A Columnar cell change
• B Lobular carcinoma in situ (LCIS)
• C Ductal carcinoma in situ (DCIS) at the retroareolar margin ✓
• D Florid epithelial hyperplasia without atypia

Explanation

During nipple-sparing mastectomy, intraoperative frozen section of the retroareolar core is standard practice. Presence of DCIS at the retroareolar margin is an absolute contraindication to nipple preservation and mandates conversion to skin-sparing mastectomy with nipple removal, as residual DCIS under the nipple markedly increases local recurrence risk. LCIS is not a contraindication to nipple preservation in most guidelines; columnar cell change and epithelial hyperplasia without atypia are benign findings that do not affect the decision.

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

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Written and medically reviewed by the StethoPrep medical team.