Skip to main content
Top
Published in: Annals of Surgical Oncology 10/2016

01-10-2016 | Breast Oncology

Oncologic Outcomes After Nipple-Sparing Mastectomy

Authors: Tracy Ann Moo, MD, Tiffany Pinchinat, MD, Simone Mays, MD, Alyssa Landers, MA, Paul Christos, Dr.P.H., MS, Hanan Alabdulkareem, MD, Eleni Tousimis, MD, Alexander Swistel, MD, Rache Simmons, MD

Published in: Annals of Surgical Oncology | Issue 10/2016

Login to get access

Abstract

Background

Nipple-sparing mastectomy (NSM) is increasingly used as an alternative to traditional mastectomy because it provides improved aesthetic results. The data on its oncologic safety are limited. The authors’ institution has performed NSM during the past 10 years for both oncologic and prophylactic indications. This study aimed to examine oncologic outcomes after NSM for breast cancer.

Methods

The study retrospectively examined all NSM cases managed between July 2007 and July 2013. Descriptive statistics were used to characterize the study cohort. Kaplan–Meier survival analysis was performed to estimate recurrence-free survival, specifically the 36-month recurrence-free survival proportion.

Results

A total of 721 nipple-sparing mastectomies were performed for 413 patients: 45 (10.9 %) to reduce risk and 368 (89.1 %) for breast cancer. In the breast cancer group, 29.8 % of the patients had ductal carcinoma in situ, and 70.2 % had invasive cancer. The mean follow-up time was 32 months (range 0.01–90.2 months). In the breast cancer group, the Kaplan–Meier 3-year recurrence-free survival rate was 93.6 % (95 % confidence interval, 89.9–96.0 %). Eight patients (2.2 %) had locoregional recurrences, including one in the nipple. Nine patients (2.4 %) had distant recurrence, and six patients (1.6 %) had a diagnosis of both local and distant recurrences.

Conclusions

The findings showed a locoregional recurrence rate of 2.2 %, with an overall recurrence rate of 6.3 % for patients undergoing NSM for the treatment of breast cancer. The majority of these recurrences were distant, with one recurrence at the nipple. These results are promising, but a longer follow-up evaluation of this cohort is necessary.
Literature
1.
go back to reference Laronga C, Lewis JD, Smith PD. The changing face of mastectomy: an oncologic and cosmetic perspective. Cancer Control. 2012;19:286–94.PubMed Laronga C, Lewis JD, Smith PD. The changing face of mastectomy: an oncologic and cosmetic perspective. Cancer Control. 2012;19:286–94.PubMed
2.
go back to reference Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol. 1999;6:609–13.CrossRefPubMed Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol. 1999;6:609–13.CrossRefPubMed
3.
go back to reference Fisher B, Jeong JH, Anderson S, et al. Twenty-five year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Eng J Med. 2002;347:567–75.CrossRef Fisher B, Jeong JH, Anderson S, et al. Twenty-five year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Eng J Med. 2002;347:567–75.CrossRef
4.
go back to reference Lanitis S, Tekkis PP, Sgourakis G, et al. Comparison of skin-sparing mastectomy versus non–skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Ann Surg. 2010;251:632–9.CrossRefPubMed Lanitis S, Tekkis PP, Sgourakis G, et al. Comparison of skin-sparing mastectomy versus non–skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Ann Surg. 2010;251:632–9.CrossRefPubMed
5.
go back to reference Boughey JC, McLaughlin SA. Breast surgery in 2015: advances in recent years. Ann Surg Oncol. 2015;22:3157–60.CrossRefPubMed Boughey JC, McLaughlin SA. Breast surgery in 2015: advances in recent years. Ann Surg Oncol. 2015;22:3157–60.CrossRefPubMed
6.
go back to reference Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in patients with a family history of breast cancer. N Eng J Med. 1999;340:77–84.CrossRef Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in patients with a family history of breast cancer. N Eng J Med. 1999;340:77–84.CrossRef
7.
go back to reference Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2004;22:1055–62.CrossRefPubMed Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2004;22:1055–62.CrossRefPubMed
8.
go back to reference Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–7.PubMedPubMedCentral Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–7.PubMedPubMedCentral
9.
go back to reference Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008;34:143–8.CrossRefPubMed Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008;34:143–8.CrossRefPubMed
10.
go back to reference Babiera G, Simmons R. Nipple-areolar complex-sparing mastectomy: feasibility, patient selection, and technique. Ann Surg Oncol. 2010;17:S245–8.CrossRef Babiera G, Simmons R. Nipple-areolar complex-sparing mastectomy: feasibility, patient selection, and technique. Ann Surg Oncol. 2010;17:S245–8.CrossRef
12.
go back to reference De Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–22.CrossRef De Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–22.CrossRef
13.
go back to reference Maxwell GP, Storm-Dickerson T, Whitworth P, et al. Advances in nipple-sparing mastectomy: oncological safety and incision selection. Aesthet Surg J. 2011;31:310–19.CrossRefPubMed Maxwell GP, Storm-Dickerson T, Whitworth P, et al. Advances in nipple-sparing mastectomy: oncological safety and incision selection. Aesthet Surg J. 2011;31:310–19.CrossRefPubMed
14.
go back to reference Jensen JA, Orringer JS, Guiliano AE. Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol. 2011;18:1665–70.CrossRefPubMed Jensen JA, Orringer JS, Guiliano AE. Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol. 2011;18:1665–70.CrossRefPubMed
15.
go back to reference Wagner JL, Fearmonti R, Hunt KK, et al. Prospective evaluation of the nipple-areola complex-sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19:1137–44.CrossRefPubMed Wagner JL, Fearmonti R, Hunt KK, et al. Prospective evaluation of the nipple-areola complex-sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19:1137–44.CrossRefPubMed
16.
go back to reference Lagios MD, Gates EA, Westdahl, et al. A guide to the frequency of nipple involvement in breast cancer: a study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. Am J Surg. 1979;138:135–42.CrossRefPubMed Lagios MD, Gates EA, Westdahl, et al. A guide to the frequency of nipple involvement in breast cancer: a study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. Am J Surg. 1979;138:135–42.CrossRefPubMed
17.
go back to reference Gerber B, Krause A, Dieterich M, et al. The oncological safety of skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg. 2009;249:461–8.CrossRefPubMed Gerber B, Krause A, Dieterich M, et al. The oncological safety of skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg. 2009;249:461–8.CrossRefPubMed
18.
go back to reference De La Cruz L, Moody AM, Tappy EE, et al. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol. 2015; 22:3241–9.CrossRef De La Cruz L, Moody AM, Tappy EE, et al. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol. 2015; 22:3241–9.CrossRef
19.
go back to reference Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–22.CrossRefPubMed Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–22.CrossRefPubMed
20.
go back to reference Burdge EC, Yuen J, Hardee M, et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol. 2013;20:3294–302.CrossRefPubMed Burdge EC, Yuen J, Hardee M, et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol. 2013;20:3294–302.CrossRefPubMed
21.
go back to reference Agarwal S, Agarwal S, Neumayer L, et al. Therapeutic nipple-sparing mastectomy trends based on a national cancer database. Am J Surg. 2014;208:93–8.CrossRefPubMed Agarwal S, Agarwal S, Neumayer L, et al. Therapeutic nipple-sparing mastectomy trends based on a national cancer database. Am J Surg. 2014;208:93–8.CrossRefPubMed
22.
go back to reference Krajewski AC, Boughey JC, Degnim AC, et al. Expanded indications and improved outcomes for nipple-sparing mastectomy over time. Ann Surg Oncol. 2015;22:3317–23.CrossRefPubMed Krajewski AC, Boughey JC, Degnim AC, et al. Expanded indications and improved outcomes for nipple-sparing mastectomy over time. Ann Surg Oncol. 2015;22:3317–23.CrossRefPubMed
23.
go back to reference Santoro S, Loreti A, Cavaliere F, et al. Neoadjuvant chemotherapy is not a contraindication for nipple-sparing mastectomy. The Breast. 2015;24:661–6.CrossRefPubMed Santoro S, Loreti A, Cavaliere F, et al. Neoadjuvant chemotherapy is not a contraindication for nipple-sparing mastectomy. The Breast. 2015;24:661–6.CrossRefPubMed
24.
go back to reference Alperovich M, Choi M, Karp NS, et al. Nipple-sparing mastectomy and sub-areolar biopsy: to freeze or not to freeze? Evaluating the role of subareolar intraoperative frozen section. The Breast J. 2016;22:18–23.CrossRefPubMed Alperovich M, Choi M, Karp NS, et al. Nipple-sparing mastectomy and sub-areolar biopsy: to freeze or not to freeze? Evaluating the role of subareolar intraoperative frozen section. The Breast J. 2016;22:18–23.CrossRefPubMed
Metadata
Title
Oncologic Outcomes After Nipple-Sparing Mastectomy
Authors
Tracy Ann Moo, MD
Tiffany Pinchinat, MD
Simone Mays, MD
Alyssa Landers, MA
Paul Christos, Dr.P.H., MS
Hanan Alabdulkareem, MD
Eleni Tousimis, MD
Alexander Swistel, MD
Rache Simmons, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5366-1

Other articles of this Issue 10/2016

Annals of Surgical Oncology 10/2016 Go to the issue