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Published in: World Journal of Surgery 8/2016

01-08-2016 | Original Scientific Report

Feasibility of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Breast Cancer Patients with Tumor-Nipple Distance Less Than 2.0 cm

Authors: Jai Min Ryu, Seok Jin Nam, Seok Won Kim, Se Kyung Lee, Soo Youn Bae, Ha Woo Yi, Sungmin Park, Hyun-June Paik, Jeong Eon Lee

Published in: World Journal of Surgery | Issue 8/2016

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Abstract

Background and objective

Debate continues concerning the oncological risk of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) if the tumor-nipple distance (TND) is less than 2.0 cm. In this retrospective study, we analyzed oncological outcomes after NSM with IBR for the treatment of breast cancer to determine the risk posed by NSM in cases in which magnetic resonance imaging (MRI) showed a TND <2.0 cm but intraoperative frozen biopsy results were negative for tumor cells at the nipple base.

Materials and methods

We conducted a retrospective review of patients with breast cancer who underwent NSM with IBR at Samsung Medical Center between 2008 and 2014. Preoperative MRI was done in all cases to define the TND, and frozen biopsy specimens were obtained intraoperatively.

Results

Among the 266 NSMs performed, TND was <2.0 cm in 145 cases (54.5 %) and ≥2.0 cm in 121 cases (45.5 %). Median follow-up was 25.6 months. There were no significant differences between the two patient groups with respect to disease-free survival or local recurrence-free survival.

Conclusion

Our results suggest that NSM can be a feasible treatment option when the intraoperative frozen biopsy is negative for tumor cells even with a TND <2.0 cm in MRI.
Literature
1.
go back to reference Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMed Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMed
2.
go back to reference Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA (2015) Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 150:9–16CrossRefPubMed Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA (2015) Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 150:9–16CrossRefPubMed
3.
go back to reference Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 87:1048–1053CrossRefPubMed Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 87:1048–1053CrossRefPubMed
4.
go back to reference Elder EE, Brandberg Y, Bjorklund T, Rylander R, Lagergren J, Jurell G, Wickman M, Sandelin K (2005) Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast 14:201–208CrossRefPubMed Elder EE, Brandberg Y, Bjorklund T, Rylander R, Lagergren J, Jurell G, Wickman M, Sandelin K (2005) Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast 14:201–208CrossRefPubMed
5.
go back to reference Stanec Z, Zic R, Budi S, Stanec S, Milanovic R, Vlajcic Z, Roje Z, Rudman F, Martic K, Held R, Bozo G (2014) Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience. Ann Plast Surg 73:485–491CrossRefPubMed Stanec Z, Zic R, Budi S, Stanec S, Milanovic R, Vlajcic Z, Roje Z, Rudman F, Martic K, Held R, Bozo G (2014) Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience. Ann Plast Surg 73:485–491CrossRefPubMed
6.
go back to reference Missana MC, Laurent I, Germain M, Lucas S, Barreau L (2013) Long-term oncological results after 400 skin-sparing mastectomies. J Visc Surg 150:313–320CrossRefPubMed Missana MC, Laurent I, Germain M, Lucas S, Barreau L (2013) Long-term oncological results after 400 skin-sparing mastectomies. J Visc Surg 150:313–320CrossRefPubMed
7.
go back to reference Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V et al (2009) Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 117:333–338CrossRefPubMed Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V et al (2009) Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 117:333–338CrossRefPubMed
8.
go back to reference Coopey SB, Tang R, Lei L, Freer PE, Kansal K, Colwell AS, Gadd MA, Specht MC, Austen WG Jr, Smith BL (2013) Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol 20:3218–3222CrossRefPubMed Coopey SB, Tang R, Lei L, Freer PE, Kansal K, Colwell AS, Gadd MA, Specht MC, Austen WG Jr, Smith BL (2013) Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol 20:3218–3222CrossRefPubMed
9.
go back to reference Poruk KE, Ying J, Chidester JR, Olson JR, Matsen CB, Neumayer L, Agarwal J (2015) Breast cancer recurrence after nipple-sparing mastectomy: one institution’s experience. Am J Surg 209:212–217CrossRefPubMed Poruk KE, Ying J, Chidester JR, Olson JR, Matsen CB, Neumayer L, Agarwal J (2015) Breast cancer recurrence after nipple-sparing mastectomy: one institution’s experience. Am J Surg 209:212–217CrossRefPubMed
10.
go back to reference Freeman BS (1967) Complications of subcutaneous mastectomy with prosthetic replacement, immediate or delayed. South Med J 60:1277–1280CrossRefPubMed Freeman BS (1967) Complications of subcutaneous mastectomy with prosthetic replacement, immediate or delayed. South Med J 60:1277–1280CrossRefPubMed
11.
go back to reference Simmons RM, Brennan M, Christos P, King V, Osborne M (2002) Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 9:165–168CrossRefPubMed Simmons RM, Brennan M, Christos P, King V, Osborne M (2002) Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 9:165–168CrossRefPubMed
12.
go back to reference Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE (1999) The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 6:609–613CrossRefPubMed Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE (1999) The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 6:609–613CrossRefPubMed
13.
go back to reference Brachtel EF, Rusby JE, Michaelson JS, Chen LL, Muzikansky A, Smith BL, Koerner FC (2009) Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol 27:4948–4954CrossRefPubMed Brachtel EF, Rusby JE, Michaelson JS, Chen LL, Muzikansky A, Smith BL, Koerner FC (2009) Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol 27:4948–4954CrossRefPubMed
14.
go back to reference Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, Petty PM, Sellers TA, Johnson JL, McDonnell SK et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84CrossRefPubMed Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, Petty PM, Sellers TA, Johnson JL, McDonnell SK et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84CrossRefPubMed
15.
go back to reference Luo D, Ha J, Latham B, Ingram D, Connell T, Hastrich D, Yeow WC, Willsher P, Luo J (2010) The accuracy of intraoperative subareolar frozen section in nipple-sparing mastectomies. Ochsner J 10:188–192PubMedPubMedCentral Luo D, Ha J, Latham B, Ingram D, Connell T, Hastrich D, Yeow WC, Willsher P, Luo J (2010) The accuracy of intraoperative subareolar frozen section in nipple-sparing mastectomies. Ochsner J 10:188–192PubMedPubMedCentral
16.
go back to reference Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC et al (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 203:704–714CrossRefPubMed Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC et al (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 203:704–714CrossRefPubMed
17.
go back to reference Gerber B, Krause A, Dieterich M, Kundt G, Reimer T (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249:461–468CrossRefPubMed Gerber B, Krause A, Dieterich M, Kundt G, Reimer T (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249:461–468CrossRefPubMed
18.
go back to reference Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R et al (2009) Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 114:97–101CrossRefPubMed Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R et al (2009) Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 114:97–101CrossRefPubMed
19.
go back to reference Kim HJ, Park EH, Lim WS, Seo JY, Koh BS, Lee TJ, Eom JS, Lee SW, Son BH, Lee JW, Ahn SH (2010) Nipple areola skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study. Ann Surg 251:493–498CrossRefPubMed Kim HJ, Park EH, Lim WS, Seo JY, Koh BS, Lee TJ, Eom JS, Lee SW, Son BH, Lee JW, Ahn SH (2010) Nipple areola skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study. Ann Surg 251:493–498CrossRefPubMed
20.
go back to reference Paepke S, Schmid R, Fleckner S, Paepke D, Niemeyer M, Schmalfeldt B, Jacobs VR, Kiechle M (2009) Subcutaneous mastectomy with conservation of the nipple-areola skin: broadening the indications. Ann Surg 250:288–292CrossRefPubMed Paepke S, Schmid R, Fleckner S, Paepke D, Niemeyer M, Schmalfeldt B, Jacobs VR, Kiechle M (2009) Subcutaneous mastectomy with conservation of the nipple-areola skin: broadening the indications. Ann Surg 250:288–292CrossRefPubMed
21.
go back to reference Jensen JA, Orringer JS, Giuliano AE (2011) Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol 18:1665–1670CrossRefPubMed Jensen JA, Orringer JS, Giuliano AE (2011) Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol 18:1665–1670CrossRefPubMed
22.
go back to reference Warren Peled A, Foster RD, Stover AC, Itakura K, Ewing CA, Alvarado M, Hwang ES, Esserman LJ (2012) Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol 19:3402–3409CrossRefPubMed Warren Peled A, Foster RD, Stover AC, Itakura K, Ewing CA, Alvarado M, Hwang ES, Esserman LJ (2012) Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol 19:3402–3409CrossRefPubMed
23.
go back to reference Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, Yang Q (2013) Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol 30:481CrossRefPubMed Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, Yang Q (2013) Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol 30:481CrossRefPubMed
24.
go back to reference Adam H, Bygdeson M, de Boniface J (2014) The oncological safety of nipple-sparing mastectomy—a Swedish matched cohort study. Eur J Surg Oncol 40:1209–1215CrossRefPubMed Adam H, Bygdeson M, de Boniface J (2014) The oncological safety of nipple-sparing mastectomy—a Swedish matched cohort study. Eur J Surg Oncol 40:1209–1215CrossRefPubMed
25.
go back to reference Rusby JE, Brachtel EF, Othus M, Michaelson JS, Koerner FC, Smith BL (2008) Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy. Br J Surg 95:1356–1361CrossRefPubMed Rusby JE, Brachtel EF, Othus M, Michaelson JS, Koerner FC, Smith BL (2008) Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy. Br J Surg 95:1356–1361CrossRefPubMed
26.
go back to reference Byon W, Kim E, Kwon J, Park YL, Park C (2014) Magnetic resonance imaging and clinicopathological factors for the detection of occult nipple involvement in breast cancer patients. J Breast Cancer 17:386–392CrossRefPubMedPubMedCentral Byon W, Kim E, Kwon J, Park YL, Park C (2014) Magnetic resonance imaging and clinicopathological factors for the detection of occult nipple involvement in breast cancer patients. J Breast Cancer 17:386–392CrossRefPubMedPubMedCentral
27.
go back to reference Eriksen C, Frisell J, Wickman M, Lidbrink E, Krawiec K, Sandelin K (2011) Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study. Breast Cancer Res Treat 127:439–446CrossRefPubMed Eriksen C, Frisell J, Wickman M, Lidbrink E, Krawiec K, Sandelin K (2011) Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study. Breast Cancer Res Treat 127:439–446CrossRefPubMed
28.
go back to reference de Alcantara Filho P, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS (2011) Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol 18:3117–3122CrossRefPubMed de Alcantara Filho P, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS (2011) Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol 18:3117–3122CrossRefPubMed
29.
go back to reference Steen ST, Chung AP, Han SH, Vinstein AL, Yoon JL, Giuliano AE (2013) Predicting nipple-areolar involvement using preoperative breast MRI and primary tumor characteristics. Ann Surg Oncol 20:633–639CrossRefPubMed Steen ST, Chung AP, Han SH, Vinstein AL, Yoon JL, Giuliano AE (2013) Predicting nipple-areolar involvement using preoperative breast MRI and primary tumor characteristics. Ann Surg Oncol 20:633–639CrossRefPubMed
30.
go back to reference Yao K, Liederbach E, Tang R, Lei L, Czechura T, Sisco M, Howard M, Hulick PJ, Weissman S, Winchester DJ et al (2015) Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol 22:370–376CrossRefPubMed Yao K, Liederbach E, Tang R, Lei L, Czechura T, Sisco M, Howard M, Hulick PJ, Weissman S, Winchester DJ et al (2015) Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol 22:370–376CrossRefPubMed
Metadata
Title
Feasibility of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Breast Cancer Patients with Tumor-Nipple Distance Less Than 2.0 cm
Authors
Jai Min Ryu
Seok Jin Nam
Seok Won Kim
Se Kyung Lee
Soo Youn Bae
Ha Woo Yi
Sungmin Park
Hyun-June Paik
Jeong Eon Lee
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 8/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3487-0

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