ASO Author Reflections: Nipple-Sparing Mastectomy Increasingly Utilized for Patients with Locally Advanced Disease Who Demonstrate Response to Neoadjuvant Chemotherapy

Excerpt

Over the last decade, indications for therapeutic nipple-sparing mastectomy (NSM) have continued to expand. While early guidelines restricted candidacy to those with biologically favorable, node-negative disease, the most recent 2019 National Comprehensive Cancer Network (NCCN) guidelines suggest that NSM may be considered for in situ, early-stage, or locally advanced cancers, provided the nipple margin is pathologically assessed. These evolving guidelines have taken into account the growing body of literature suggesting NSM may be an acceptable option in the setting of neoadjuvant systemic therapy for locally advanced disease,1 with recent single-institution studies demonstrating no difference in postoperative complications and short-term local recurrence rates following neoadjuvant treatment.2,3 However, whether a nipple-sparing approach has been more broadly adopted across the United States for locally advanced patients remains less well established. …