Nipple sparing mastectomy for breast cancer is associated with high patient satisfaction and safe oncological outcomes

Mesdag, Violette; Régis, Claudia; Tresch, Emmanuelle; Chauvet, Marie‐Pierre; Boulanger, L.; Collinet, Pierre; Giard, S.

doi:10.1016/j.jogoh.2017.07.003

Cited by 30 publications

(24 citation statements)

References 19 publications

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Breast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The more desirable cosmetic outcomes achieved with preservation of the nipple–areola complex have shown quality‐of‐life benefits. Patients undergoing NSM have better psychosocial and sexual well‐being, and improved cosmesis, body image and nipple sensation. Concerns, however, remain regarding the oncological safety of the procedure because of the potential for residual breast tissue beneath the nipple–areola complex or elsewhere on the chest wall, and the lack of long‐term outcome data for patients at highest risk of developing breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Use of bilateral prophylactic nipple-sparing mastectomy in patients with high risk of breast cancer

Valero¹,

Moo²,

Muhsen³

et al. 2020

British Journal of Surgery

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Background Nipple‐sparing mastectomy (NSM) is being performed increasingly for risk reduction in high‐risk groups. There are limited data regarding complications and oncological outcomes in women undergoing bilateral prophylactic NSM. This study reviewed institutional experience with prophylactic NSM, and examined the indications, rates of postoperative complications, incidence of occult malignant disease and subsequent breast cancer diagnosis. Methods Women who had bilateral prophylactic NSM between 2000 and 2016 were identified from a prospectively maintained database. Rates of postoperative complications, incidental breast cancer, recurrence and overall survival were evaluated. Results A total of 192 women underwent 384 prophylactic NSMs. Indications included BRCA1 or BRCA2 mutations in 117 patients (60·9 per cent), family history of breast cancer in 35 (18·2 per cent), lobular carcinoma in situ in 29 (15·1 per cent) and other reasons in 11 (5·7 per cent). Immediate breast reconstruction was performed in 191 patients. Of 384 NSMs, 116 breasts (30·2 per cent) had some evidence of skin necrosis at follow‐up, which resolved spontaneously in most; only 24 breasts (6·3 per cent) required debridement. Overall, there was at least one complication in 129 breasts (33·6 per cent); 3·6 and 1·6 per cent had incidental findings of ductal carcinoma in situ and invasive breast cancer respectively. The nipple–areola complex was preserved entirely in 378 mastectomies. After a median follow‐up of 36·8 months, there had been no deaths and no new breast cancer diagnoses. Conclusion These findings support the use of prophylactic NSM in high‐risk patients. The nipples could be preserved in the majority of patients, postoperative complication rates were low, and, with limited follow‐up, there were no new breast cancers.

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“…With primary implant reconstruction, NSM has become the best treatment option for women requiring mastectomy due to better cosmetic result, greater satisfaction, and better quality of life compared to modified radical mastectomy or skin-sparing mastectomy [5,6]. Breast reconstructions are subject to possible early postoperative complications related to either wound healing or flap viability that can lead to prolonged convalescent periods, albeit without causing significant delays in adjuvant chemotherapy or radiotherapy [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

et al. 2018

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Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m², and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

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Nipple sparing mastectomy for breast cancer is associated with high patient satisfaction and safe oncological outcomes

Cited by 30 publications

References 19 publications

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

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

Use of bilateral prophylactic nipple-sparing mastectomy in patients with high risk of breast cancer

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

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