Evidence-based nipple-sparing mastectomy in patients with higher body mass index: Recommendations for a successful standardized surgery

Nipple-sparing mastectomy is used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer. This technique allows to remove the entire glandular tissue preserving the skin envelope and the nipple-areola complex. Common indications to nipple-sparing mastectomy include extensive or multicentric disease, inability to obtain clear surgical margins with breast conserving-surgery, large tumor size with respect to the breast size, as well as cases with contraindications for radiotherapy as well as patient preference. Higher body mass index may cause longer operative times and increased risk of complications such as nipple-areola complex and skin flap ischemia. Repetitive performance of standardized tasks could optimize oncological and aesthetic outcomes and increase the chance of success.