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Mr Gordon and his colleagues describe mastectomy with areola preservation (NEAT) in carefully selected cases, and point out the advantage of areola preservation for the patient (April 2001 JRSM, pp. 185-186). However, preservation of the outer nipple can further improve cosmesis without compromising oncological principles.
Experience with total duct excision has shown that a demarcation exists between the outer dermo-fibromuscular covering of the nipple and the central duct core. This plane may be utilized to remove the apex of the nipple containing the duct orifices, together with the central duct core, while preserving the outer nipple. This operation, designated ‘core nipple duct excision’, is readily combined with mastectomy. It leaves a diminished (but much appreciated by the patient) nipple in continuity with the areola.
The details of the operation and the relevant oncological considerations have been described fully1. Case 3 in Gordon's paper would be eminently suited to this procedure, as would all cases where low-grade cancer is reasonably distanced from the nipple ducts, as required for the NEAT operation.