Nipple-Sparing Mastectomy with Intraoperative Radiation Therapy (IORT Nipple)

Nipple-Sparing Mastectomy with Intraoperative Radiation Therapy (IORT Nipple)

Associate Professor Youwanush Kongdan, MD.

Nipple-Sparing Mastectomy (NSM) is a surgical technique that preserves the nipple and breast skin while removing all cancer-affected breast tissue. This approach is widely accepted for suitable patients as it maintains the natural appearance of the breast and significantly boosts patient confidence.

When combined with Intraoperative Radiation Therapy (IORT) targeting the nipple, it enhances the safety of nipple preservation by reducing the risk of cancer recurrence in the nipple area.

Steps in Nipple-Sparing Mastectomy with IORT Nipple

1. Surgical Planning and Patient Evaluation

   • The surgeon evaluates whether the patient is a candidate for nipple preservation, considering factors such as the tumor's size, location, distance from the nipple, and surrounding tissue characteristics.

2. Nipple-Sparing Mastectomy

   • The surgeon removes all breast tissue while preserving the nipple and skin.

   • If minor abnormalities are detected in the nipple area, tissue samples may be taken for pathological examination to ensure safety.

3. Intraoperative Radiation Therapy (IORT)

   • An IORT device is used to deliver targeted radiation beneath the nipple immediately after the removal of breast tissue.

   • This radiation eliminates any residual cancer cells in the nipple area or surrounding tissue.

4. Breast Reconstruction

   • Following radiation, the surgeon reconstructs the breast using either silicone implants or the patient’s own tissue, such as from the abdomen or back.

Advantages of Nipple-Sparing Mastectomy with IORT Nipple

• Preservation of Aesthetics: Retaining the nipple and skin results in a breast appearance that closely resembles its natural state.

• Reduced Cancer Recurrence Risk: Targeted radiation enhances safety by eradicating residual cancer cells.

• Shorter Treatment Time: IORT reduces the need for additional post-operative radiation therapy.

Limitations and Considerations

• Not Suitable for All Patients: Patients with cancer located in or near the nipple that cannot be entirely removed may not be eligible.

• Requires Expertise and Advanced Technology: The procedure demands a highly skilled surgical team and the availability of IORT equipment in the operating room.

• Potential Complications: Risks include nipple necrosis (tissue death) and infection.

At present, Namarak Hospital has adopted this technique to improve the quality of life and self-image for breast cancer patients.

Conclusion

Nipple-Sparing Mastectomy with IORT Nipple is an innovative approach that enhances the safety of nipple preservation without compromising cancer control. This technique is ideal for patients with low-risk nipple involvement who desire a natural post-operative appearance. Namarak Hospital is equipped with advanced technology and a team of experts to deliver safe and effective treatment.