Background: Although the association of human papillomavirus (HPV) with many cancers is well established, the involvement of HPV in breast cancer remains controversial. The purpose of this study is to perform a comprehensive review of the results and methods used to demonstrate that HPV markers are present in human breast cancer, and how well these studies fulfil the criteria for proving the viral etiology of a cancer. Study Design: We conducted a search for molecular studies published until November 2016 that relate human breast cancer to HPV. Results: Forty-three original molecular studies were found, some of which compared cases to nonneoplastic controls. Some investigations did not identify HPV in mammary tissue, but others identified it with different frequencies of positivity, varying between 1.2 and 86%. In most case-control studies (21/24 studies), positivity in cases was found to be higher than in controls, but odds ratios and confidence intervals were not reported. Conclusion: The results are controversial. However, they arouse a great interest in the potential participation of HPV in breast carcinogenesis, but rather as an essential cause-effect participant, at least as a co-participant in some cases. The circumstance of HPV positivity in breast cancer can be criticized, but the elements that clearly demonstrate it in a number of cases are also relevant.

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Introduction: Nipple-sparing mastectomy (NSM) is a conservative mastectomy approach for breast cancer with oncological safety and good aesthetic satisfaction; however, many surgeons still have concerns about complication rates, especially nipple-areolar complex (NAC) necrosis. Objective: The aim of this study was to analyze the complication rates of 1001 NSM performed in a Brazilian cohort. Methods: Between January 2004 and August 2020, we evaluated 534 patients who underwent 1001 NSMs. All patients were operated by the same surgeon; the data were retrospectively evaluated by the medical chart and the patient’s follow-up was updated during the appointments. Results: The majority of indications for NSM were for breast cancer treatment (78%), followed by bilateral risk-reducing mastectomy (BRRM) (18.7%) and contralateral prophylactic mastectomy (3.3%). In total, 416 patients underwent therapeutic NSM, 85.3% for primary tumor treatment, 9.2% presented recurrence of a previous breast cancer, and 5.5% had compromised margins after previous breast-conserving surgery (BCS). Bilateral NSM was performed in 367 (88.2%) patients and unilateral surgery in 49 (11.8%) patients. Among the 100 patients who underwent BRRM, 27% had a previous breast cancer and 55% presented a genetic mutation in highly penetrant genes. Breast reconstruction was performed using silicon prosthetic implants for 91.8%, tissue expander for only 6.8% of patients, and for 1.4% of patients we do not have the data. In the 1001 NSM performed, we observed 4.4% of overall complications, including 1.1% of hematoma needing operation, 1.5% of infection, 1% of partial, and 0.2% of total nipple necrosis. Patients with previous breast cancer treated with BCS and radiotherapy had higher complication rates (21%) than in patients with no previous breast cancer treatment (6.4%), and patients >50 years old presented twofold more chance of having postoperative complications than patients <50 years old. Conclusion: We observed an overall postoperative complication rate of 4.4% and low nipple necrosis in 1001 NSM performed by the same surgeon. Older age and previous breast cancer history might be risk factors for increased complication rates following this procedure.

Objective Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Methods Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. Results The patients were followed up for a mean time of 132 months since the first surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. Conclusion In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy.

Introduction: Nipple-sparing mastectomy (NSM) is a conservative mastectomy approach for breast cancer with oncological safety and good aesthetic satisfaction. The initial indications of NSM excluded patients with previous radiation, ptosis, high body mass index (BMI) and macromastia, although these contraindications have been challenged. Different authors expanded the classic indications of NSM for patients with previous breast surgery/irradiation, neoadjuvant chemotherapy, and short tumor-nipple distance and showed safety and low complication rates. However, there are few data about the suitability of performing NSM with immediate reconstruction for the treatment of recurrent disease. Objectives: The aim of this study was to analyze the complication and local recurrence rates of 24 patients with indication of mastectomy, however with no skin or nipple involvement, who opted to undergo NSMs with immediate reconstruction for the treatment of ipsilateral breast tumor recurrence (IBTR). Methods: Between January 2001 and December 2018, we evaluated 24 patients that underwent NSMs for the treatment of IBRT after a previous BCS (breast cancer surgery) followed by radiotherapy. All patients were operated by the same surgeon, the data were retrospectively evaluated by the medical chart and the patient`s follow-up was updated during the appointments. Results: The patient’s mean age in the salvage surgery was 49 years. The majority of patients (70.8%) underwent bilateral procedures, one (5.9%) patient due to the diagnosis of invasive cancer in both breasts, one (5.9%) DCIS in both breasts, and 15 (88.2%) patients without disease in the contralateral breast, most of them for prophylactic or aesthetic reasons to avoid asymmetry and to reach a better aesthetic result. Breast reconstruction was performed using silicone prosthetic implants for 22 (91.7%) patients and with tissue expander for only two (8.3%) patients. Patients were followed for a mean time of 132 months since the first surgery. In the mean follow-up of 40 months after the NSM surgery, five (20.8%) patients were diagnosed with local recurrence and only one patient died from the progression of the disease. Patients presented 4.8% of partial and 2.4% of total nipple necrosis. No infection and no implant loss was observed. Conclusions: In the long-term follow-up since the first surgery, we observed low complication rates and a good survival rate, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients with indication of mastectomy, with no skin or NAC (nipple-areola complex) involvement, who did not want to undergo total mastectomy with resection of the skin and NAC.