Background: In recent years, immediate breast reconstruction has become the standard of care in breast cancer surgery. In particular, skin-sparing mastectomy followed by immediate breast reconstruction has been adopted for patients with early breast cancer. Objectives: We review the literature regarding immediate breast reconstruction, and discuss the outlook for nipple-areola complex (NAC) preserving and skin-sparing mastectomy with immediate reconstruction. Findings: Skin-sparing mastectomy with immediate reconstruction not only satisfies oncologic requirements but also provides superior reconstructive results when compared with conventional techniques. In this procedure, the breast tissue, nipple-areola complex (NAC), previous biopsy incision and skin overlying superficial tumors are removed. However, occult NAC involvement occurs in a small percentage of patients undergoing skin-sparing mastectomies. Since some of the NAC involvement can be identified on frozen section examination, the probability of missing occult tumor involvement of the NAC would be extremely rare in selected patients. When the NAC and uninvolved mammary skin can be preserved, it greatly improves the aesthetic quality of immediate breast reconstruction. Conclusion: Preservation of the NAC may be appropriate for selected patients, although the long-term risks remain to be assessed.
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