A Tumor Ultrasound-guided Incision (TUGI) Approach to Nipple-sparing Mastectomy: Balancing Oncologic Safety and Technical Outcomes

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Nipple-sparing mastectomy (NSM) is a prevalent operation for patients with breast cancer. Indications have been limited to tumors accessible via radial, infra-mammary, or periareolar incisions out of concern for oncologic and technical safety. We study an alternative approach to NSM based on tumor ultrasound-guided incisions (TUGI) and report its oncologic and technical outcomes.

Materials and Methods:

A retrospective chart review examined patients who underwent TUGI NSM between 2013 and 2016. Operative notes, postoperative notes, pathology reports, and postoperative photography were analyzed.


Ninety-four patients had mastectomy with reconstruction performed over a 3-year period by the senior authors. Of those, 31 (33%) were NSM and 13 (14%) had the TUGI technique, forming the study group. The median tumor size was 1.5 cm, with a median distance from the nipple areolar complex of 5 cm. Sixty-two percent of the incisions were in the upper quadrants of the breast. Median operative time was 207 minutes. Zero patients had positive margins. One hundred percent of patients underwent immediate tissue expander placement, 46% with acellular dermal matrix. For final reconstruction, 23% had a free flap, 69% implant, and 8% are still pending. Eight percent of patients had wound infection, and 15% of patients had NAC necrosis. No cancer recurrence has been observed at a median follow-up of 17 months.


TUGI offers a valuable, oncologically sound alternative approach to traditional NSM. The technical results and outcomes support its use in selected patients with breast cancer undergoing NSM.


Not all breast cancer patients are candidates for nipple-sparing mastectomy (NSM) through standard incisions. We present our initial experience with a tumor ultrasound-guided incision approach to NSM through a retrospective review of our cohort of 13 patients. We show that oncologic safety is preserved with this technique with good technical result. Tumor ultrasound-guided incision safely extends the indications for NSM.

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