الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Breast cancer is currently the top cancer in women worldwide. Techniques that are used in treatment of this disease have evolved through the years to eradicate the tumor cells completely while restoring the patients’ pre-disease state. Breast conservative surgery has gained enormous popularity because it appears to eradicate breast cancer without increased recurrence at primary site, yet preserving a maximal volume of breast tissue.
The nipple-areolar complex (NAC) is integral to women’s body image and quality of life. Dissatisfaction with conventional methods of nipple reconstruction aftermastectomy and increase in incidence of prophylactic mastectomy in high-risk patients of younger age also contribute to growing interest in nipple-sparing mastectomy (NSM).
The indications of Nipple Sparing Mastectomy (NSM) are being broadened, including prophylactic or risk-reduction mastectomy and therapeutic mastectomy for both benign and malignant breast diseases.
Two techniques for management of the nipple core have evolved. The nipple core may be excised, by sharp dissection or using point diathermy aiming to minimize the chance of residual disease or recurrence of the disease in the nipple. This technique risks compromising nipple viability
The alternative method is to preserve a pad of breast tissue behind the nipple assuming that this tissue carries the blood supply to the nipple followed by dose of intraoperative radiotherapy
Gerber et al. demonstrated that NAC preservation does not increase the risk of local recurrence in comparison with modified radical mastectomy (MRM)if a frozen section from underneath the nipple is intraoperatively examined and confirmed to be free of tumor cells
Breast reconstruction is a vital component in the management of breast cancer. Reconstruction lessens the psychological and physical burden of the diagnosis.
A spectrum of techniques is available from which the patient and surgeon can choose. These techniques can involve non autologus (breast implants), autologous tissue, or both.
Both implant and autologous tissue reconstructive techniques have been proven safe oncologically. Breast cancer can recur with or without surgery; it is usually noted superficially along the mastectomy scar line. If a recurrence is being detected late due to reconstruction, long-term survival is not altered by the surgery.