Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy

Santoro, Stefano; Loreti, Andrea; Cavaliere, F.; Costarelli, Leopoldo; Pinta, Massimo La; Manna, Elena; Mauri, M.; Scavina, Paola; Santini, E.; Paula, Ugo De; Toto, Vito; Fortunato, Lucio

doi:10.1016/j.breast.2015.08.001

Cited by 66 publications

(37 citation statements)

References 29 publications

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“…For example, some groups are performing NSM when the tumor is less than 2 cm from NAC. [14]. The same group and others [15] are also performing NSM in selected patients after neoadjuvant chemotherapy.…”

Section: Oncological Safetymentioning

confidence: 99%

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

et al. 2017

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Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. NSM is closely similar except that the nipple-areola complex (NAC) is also conserved. Meta-analyses indicate that outcomes for SSM and NSM do not differ from those for non-conservative mastectomies. Recurrence rates in the NAC after NSM are acceptably low (0-3.7%). Other studies indicate that NSM is associated with high patient satisfaction and good psychological adjustment. Indications are carcinoma or DCIS that require mastectomy (including after neoadjuvant chemotherapy). NSM is also suitable for women undergoing risk-reducing bilateral mastectomy. Tumor not less than 2cm from the NAC is recommended, but may be less important than no evidence of nipple involvement on mandatory intraoperative nipple margin assessment. A positive margin is an absolute contraindication for nipple preservation. Other contraindications are microcalcifications close to the subareolar region and a positive nipple discharge. Complication rates are similar to those for other types of post-mastectomy reconstructions. The main complication of NSM is NAC necrosis, however as surgeon experience matures, frequency declines. Factors associated with complications are voluminous breast, ptosis, smoking, obesity, and radiotherapy. Since the access incision is small, breast tissue may be left behind, so only experienced breast surgeons should do these operations; close collaboration with the plastic surgeon. For breast cancer patients requiring mastectomy, NSM should be the option of choice.

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Section: Oncological Safetymentioning

confidence: 99%

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

et al. 2017

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“…This in turn had improvement in patient satisfaction and psychosexual benefit. The NSM is a safe surgical procedure even in patients undergoing neo-adjuvant chemotherapy, and they are also suitable in prophylactic mastectomies in high-risk women [21, 22]. For its feasibility, it is a mandatory negative retro-areolar frozen section.…”

Section: Surgerymentioning

confidence: 99%

Highlights from the 15th St Gallen International Breast Cancer Conference 15–18 March, 2017, Vienna: tailored treatments for patients with early breast cancer

Morigi¹

2017

ecancer

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The 15th St Gallen International Breast Cancer Conference was held in Vienna for the second time, from 15th–18th March 2017. 4000 people from 105 countries all over the world were invited to take part in the event. The real highlight of the conference was the last day with the International Consensus Session which was chaired by around 50 experts on breast cancer worldwide. With reference to data from scientific research, the consensus panel tried to offer guidelines for the management of breast cancer with the aim of providing patients with optimal treatment. The topics covered focused on the treatment of breast cancer, consideration of surgery, radiotherapy, neo-adjuvant, and adjuvant systemic therapy for breast cancer, as well as genetics and prevention of breast cancer.In particular, in terms of precision medicine, an important topic of the conference was ‘is it possible to think that it could become routine in clinical practice to use immunotherapy and targeted therapy based on genetic signatures?’In view of personalised therapy, it is important to take into consideration women’s treatment preferences. It is also important not only to offer guidelines which help breast cancer experts all over the world to choose the proper treatment for women with breast cancer but also to discuss the pros and cons of the therapy with the patient. This allows for a better understanding of the disease.‘From the maximum tolerable to the minimum effective treatment: it is essential to escalate treatment when necessary and to de-escalate when unnecessary’. These few words could summarise the meaning of the 15th St Gallen International Breast Cancer Conference. Prof Martine Piccart-Gebhart was awarded with the St Gallen International Breast Cancer Award 2017 for her fundamental clinical research contribution and Prof Giuseppe Curigliano with the Umberto Veronesi Memorial Award which aims to recognise a physician’s leading role in advancing the science and care of breast cancer patients. Curigliano, in his lecture, spoke about the revolutionary immunotherapy in the clinical management of breast cancer (BC). For the development of these therapies, it is necessary to identify the genetic determinants of BC immune phenotypes in which The Cancer Genome Atlas (TCGA) has contributed towards this.For example, the T helper (Th-1) phenotype (ICR4), which also exhibits upregulation of immune-regulatory transcripts (eg. PDL1, PD1, FOXP3, IDO1, and CTLA4), was associated with prolonged patients’ survival. Chromosome segment 4q21, which includes genes encoding the Th-1 chemokines CXCL9-11, was significantly amplified only in the immune favourable phenotype (ICR4). The mutation and neo-antigen load progressively decreased from ICR4 to ICR1 but could not explain immune phenotypic differences. Mutations of TP53 were enriched in the immune favourable phenotype (ICR4). Instead, the presence of MAP3K1 and MAP2K4 mutations were closely associated with an immune unfavourable phenotype (ICR1). Using both the TCGA and the validation dataset, the degree ...

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“…There have been a limited number of studies evaluating complication rates in patients undergoing NAC followed by SSM or NSM with IR, with conflicting results demonstrated. [21][22][23][24][25][26][27] Several studies have demonstrated no increased risk in patients having immediate reconstruction following NAC. 21,[24][25][26][27] On the other hand, others have reported very high complication rates in this setting.…”

Section: Rates Of Lrr In Patients With Smaller Tumors Have Been Repormentioning

confidence: 99%

Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy

Wengler

Valente

Al‐Hilli

et al. 2017

Journal of Surgical Oncology

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Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy

Cited by 66 publications

References 29 publications

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

Highlights from the 15th St Gallen International Breast Cancer Conference 15–18 March, 2017, Vienna: tailored treatments for patients with early breast cancer

Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy

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