Expanding the use of nipple sparing mastectomy: A review of the indications and techniques

The nipple sparing mastectomy (NSM) has allowed for targeted tumor extirpation while maintaining the breast skin envelope and nipple-areola complex. Initially, the indications for this reconstructive technique were quite narrow, but ongoing investigation have expanded the indications and safety profile of the NSM from an oncologic and reconstructive standpoint. Historically, patients with elevated body mass index, macromastia, high-grade ptosis, and ongoing tobacco use were deemed high-risk candidates for ischemic complications. Development and utilization of numerous techniques have allowed the NSM to be offered more frequently to these high-risk candidates. Specifically, many methods including single-stage and multi-stage/delay techniques have been developed for the patient with high-grade ptosis.