Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy

Rusby, Jennifer E.; Brachtel, Elena F.; Taghian, Alphonse; Michaelson, James S.; Koerner, Frederick C.; Smith, Barbara L.

doi:10.1016/j.amjsurg.2007.06.019

« Previous Next »The American Journal of Surgery
Volume 194, Issue 4 , Pages 433-437, October 2007

Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy

Presented at the 8th Annual Meeting of the American Society of Breast Surgeons, Phoenix, AZ, May 2–6, 2007

Jennifer E. Rusby, M.D.
- Division of Surgical Oncology, Yawkey 9A, Massachusetts General Hospital, Fruit St, Boston, MA 02114, USA
Elena F. Brachtel, M.D.
- Department of Pathology, Warren 2, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
Alphonse Taghian, M.D., Ph.D.
- Department of Radiation Oncology, Cox 3, Massachusetts General Hospital, Blossom St, Boston, MA 02114, USA
James S. Michaelson, Ph.D.
- Division of Surgical Oncology, Yawkey 9A, Massachusetts General Hospital, Fruit St, Boston, MA 02114, USA
Frederick C. Koerner, M.D.
- Department of Pathology, Warren 2, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
Barbara L. Smith, M.D., Ph.D.
- Division of Surgical Oncology, Yawkey 9A, Massachusetts General Hospital, Fruit St, Boston, MA 02114, USA
- Corresponding author. Tel.: +1-617-724-1074; fax: +1-617-724-1079.

Received 1 May 2007; received in revised form 28 June 2007

Abstract

Background

Precise anatomical relationships between ducts and vasculature within the nipple remain unknown. This study investigated nipple microvessels and their position relative to ducts.

Methods

Nipple and duct bundle cross-sectional areas were measured in 48 specimens. Vessels located within the central duct bundle or within a peripheral rim were counted in 7 non-irradiated and 5 irradiated nipples.

Results

Mean nipple diameter was 11.1 mm and duct bundle diameter 5.2 mm. A 2-mm and a 3-mm peripheral rim of nipple tissue would result in complete duct excision in 96% and 87% of sections, respectively. Twenty-nine percent of vessels are located in the duct bundle. A 2-mm rim contains 50%; a 3-mm rim contains 66%. Similar proportions were seen in irradiated nipples.

Conclusions

This study describes a strategy to balance duct removal with vascular preservation. Ducts can be excised leaving a rim of nipple tissue that contains a large proportion of microvessels.

Keywords: Anatomy, Duct, Microvessel density, Nipple-sparing mastectomy