Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study

Abstract

The objective was to determine the 10-year oncological safety of nipple-sparing mastectomy (NSM) in patients diagnosed with ductal carcinoma in situ (DCIS). The use of NSM preserves the nipple-areola complex (NAC). As residual fibroglandular breast tissue can remain behind the spared NAC, its use for patient with breast cancer is controversial. The oncologic outcomes and complication rates after performing NSM compared to other techniques are still under debate and a concern when treating patients with breast cancer. We retrospectively reviewed 69 consecutive NSM patients diagnosed with DCIS during 1984-2016 at the Valencia Institute of Oncology, Valencia, Spain. 13 of 82 reviewed cases were excluded from the analysis owing to the presence of invasive tumor in the final pathologic report. All 69 patients who underwent NSM due to DCIS were included and analyzed. The indications were as follows: unfavorable correlation between tumor size and breast size in 53 patients, 10 patients with multifocal or multicentric tumors and breast cancer recurrence after breast-conserving surgery in six patients. The reconstruction was performed using a prosthetic implant: saline-filled implant 33 (47.8%) or tissue expander 36 (52.2%). No frozen section was performed in the patients included in our study. The presence of DCIS was confirmed in 60 patients and in the other nine patients we found no tumor in the mastectomy specimen (removed due to excisional biopsy procedure). High risk features were: tumor grade 3 in 27 (39.2%) cases and comedonecrosis in 32 (46.4%) cases. In 27 patients surgical axillary staging was performed and no residual disease in the axilla was observed. After a mean follow-up period of 142.6 ± 70.7 months no nipple necrosis was observed. In 15 patients (21.7%) an additional surgical procedure was performed. 48 patients (69.6%) did not receive any adjuvant treatment. Adjuvant hormone therapy was given to 20 patients (29%) and one patients received radiation therapy (1.4%). Eight patients showed a local relapse (11.6%). One patient developed a recurrence within the nipple-areola region presented as Paget's disease (1.4%). One patient presented a thorax wall relapse after 42 months of disease-free survival and died because of metastatic dissemination of the tumor. The DFS rate was 88.4% and the overall survival rate was 98.6%. In patients with DCIS that are not candidates to breast-conserving therapy, NSM is a realistic option of treatment. No case of nipple necrosis was observed. A low rate of nipple relapse (1.4%) and a good survival rate (98.5%) were observed after a median follow-up of 142.6 months.

Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications

“…The average rate of local recurrence was in line with our results which detected a total local relapse rate (NAC and skin) of 4.9%. The overall complications rate (early and late) of this study is comparable with those reported in the literature [15][16][17] and the reported risk of recurrence is low [18]. According to Stolier et al, there are not terminal duct-lobular units inside the nipple in 91% of cases and only in 9% of cases the duct-lobular units are few and located at the base of the nipple [19].…”

Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

“…Nipple-sparing mastectomy (NSM) was initially reserved for the prophylactic treatment of women with a high risk of developing breast cancer [10]. However, NSM has been increasingly used therapeutically for breast cancer where the nipple-areolar complex is not involved [11][12][13][14]. One of the most important challenges of nipple-sparing mastectomy is achieving adequate exposure to performing precise dissection in areas that are remote from the skin incision [15].…”

“Harms” Associated with Breast Cancer Screening and Reliability of Frozen Section in Older Women: In the Case of an 80 Year Old Woman

“…Although in this particular patient, the FS did not alter the next steps of the surgical procedure, a false positive FS result (in particular with an invasive cancer diagnosis) could dramatically affect surgical decisions. As an example, a DCIS diagnosis may entail "radical" treatments including mastectomy, nipple-sparing mastectomy [20,21] or breast-conserving therapy followed by adjuvant radiation in most cases. Finally, in cases of "upstaging" from DCIS to invasive ductal carcinoma [22], the false diagnosis could erroneously alter therapeutic options.…”