Nipple-Sparing Mastectomy

What is the blood supply to the nipple?

Branches of the external and internal mammary arteries (described as contributions from the internal mammary, lateral thoracic, and posterior intercostal arteries).

When the ducts are removed at the time of nipple sparing mastectomy (NSM) what percentage of the microvasculature remains?

The nipple viability is based on microvasculature. 29% of the blood vessels are within the duct bundle approaching the skin and remainder are within 3 mm under the dermis. This remains unchanged after radiation therapy.

What is the cutaneous innervation to the breast and the nipple?

The cutaneous innervation of the breast is derived from the anterior and lateral cutaneous branches of the intercostal nerves. The nipple areola complex is supplied by the anterior and lateral cutaneous branches of the fourth intercostal nerve with additional innervation by the cutaneous branches of the third and the fifth intercostal nerves.

What are absolute and relative contraindications for NSM?

Absolute contraindications: involvement of the nipple areola complex with cancer, locally advanced breast cancer with skin involvement, inflammatory breast cancer, and bloody nipple discharge.

Relative contraindications: smoking, diabetes, obesity, and large, ptotic breasts.

What are the common complications after nipple-sparing mastectomy and immediate reconstruction?