Oncological Safety and Technical Advances in Skin and Nipple-Sparing Mastectomy

Over the past decades, breast cancer surgery has evolved in an increasingly conservative direction. In this view, mastectomy has refined its role, enhancing the aesthetic value of the procedure leading to a significant improvement in women’s quality of life and related psychological distress. Further, the introduction of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM), termed by Professor Umberto Veronesi as “conservative mastectomies,” represents a significant step in the history of breast surgery. The contribution of additional new surgical techniques has enabled radical mastectomies to be carried out with good cosmetic outcomes, maintaining the appearance of the breast, thanks also to the support of immediate reconstructive surgery and a significant increase in NSM. Numerous studies to confirm the oncological safety of this procedure, in particular of nipple–areola complex preservation, indicate that saving a healthy nipple does not impact long-term survival rates. It is imperative that each case is discussed by a multidisciplinary team, taking into account all the specific clinical criteria.