276 POSTER Breast conserving surgery and immediate reconstruction with lateral tissue flap and latissimus dorsi flap through a single lateral incision

95 NSMs were performed from June 2003 to June 2006. Average age of the selected sample was 44.5 years (range 26-65). – 53 NSMs performed in T1/T2 breast cancer patients. – 12 NSMs performed by patients presenting in situ carcinoma (DCIS/ LCIS). – 15 NSMs performed according to prophylactic purpose. – 13 NSMs performed to repair the breast deformity after poor cosmetic result of previous conservative treatment. The concept of NSM is that the breast gland has to be removed completely. The area behind the areola, where the superficial fascia is interrupted, has been totally cleared out. In order to be sure that cancer cells have not spread to the NAC area, one or two round retroareolar excisions has been performed for intraoperative histological evaluation. By the first consecutive 33/95 NSMs, the skin incision was always periareolar (omega). 18/33 NSMs presented a partial (14 NSMs) or total (4 NSMs) NAC failure. In order to reduce the NAC failure and to get a better cosmetic result, we moved from a periareolar to a lateral incision. 62/95 NSMs were performed using the lateral incision. Since we introduced the lateral approach no necrotic complication were registered. The amount of total or partial NAC necrotic complication was 18/95, all with the periareolar approach. A second surgery was necessary to remove the NAC in 4/95 NSMs. Discordance between intraoperative and final histological result, occurred in 3/95 cases. These patients underwent a second surgery and the nipple was removed. Immediate breast implant reconstruction was performed. In 79/95 NSMs an immediate breast reconstruction with prostheses was performed. The average weight of the prostheses was 250 gr. Remodelling of the contra lateral breast was always performed. Nipple Sparing Mastectomy is a safe and valuable surgical option for patient with small-medium size breast, patients’ satisfaction is very high but further investigation is necessary to confirm these preliminary results.