Total Lumpectomy vs Nipple-Sparing Lumpectomy: Long-Term Outcomes and Quality of Life Considerations in Breast Cancer Surgery A Narrative Review
Marcel Grau Rodríguez, Iris Ivette Sánchez Lebrón, Edymarie Vivaldi-Marrero, Diego Enrique Collazo-IrizarryObjective
To evaluate and compare the long-term oncologic and quality-of-life outcomes of total lumpectomy (with nipple–areola complex removal) versus nipple-sparing lumpectomy (NSL) in patients undergoing breast-conserving surgery for early-stage breast cancer.
Methods
This narrative review synthesizes peer-reviewed literature from 1999 to 2025, examining clinical, cosmetic, and psychological outcomes following lumpectomy procedures with or without nipple preservation. Eligible sources included retrospective cohort studies, population-based analyses, meta-analyses, and patient-reported outcome studies. Results were organized thematically into oncologic, psychosocial, and aesthetic domains.
Results
Available data show that NSL provides oncologic safety comparable to traditional lumpectomy, with no significant differences in survival or distant recurrence. However, a modest increase in local recurrence risk has been observed in some studies. In terms of quality of life, NSL is consistently associated with better outcomes in body image, cosmetic satisfaction, and sexual well-being. Patients who undergo NSL also report lower levels of depression and anxiety during early survivorship. When nipple preservation is not feasible, immediate oncoplastic reconstruction techniques have been shown to improve satisfaction and help mitigate psychosocial distress. Lumpectomy, with no significant differences in survival or distant recurrence.
Conclusion
Nipple-sparing lumpectomy, when clinically appropriate, offers a meaningful balance between oncologic control and long-term quality of life. Preserving the nipple may enhance emotional recovery, appearance confidence, and overall patient satisfaction. Given the impact of surgical approach on survivorship, shared decision-making should integrate both oncologic safety and patient-reported values. Nipple-sparing lumpectomy, when clinically appropriate, offers a meaningful balance between oncologic control and long-term quality of life. Preserving the nipple may enhance emotional recovery, appearance, and confidence.