Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

Abstract

Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

Inframammary versus Periareolar Incision: A Comparison of Early Complications in Nipple-sparing Mastectomy

“…The mean age of the women in the periareolar group was slightly higher than that of the IMF group: 47 years (range 27-67 years) and 43.9 years (range 28-74 years), respectively (P < 0.038). Mastectomy weight was higher in the periareolar group: 312.7 g (range 116-640 g) versus 246.8 g (range 65-581 g) (P < 0.001), as was the implant volume: 447.5 cm 3 (range 300-550 cm 3 ) versus 409.00 cm 3 (range 250-575 cm 3 ) (P = 0.002). Mean BMI was 23.9 and 25.2 in the IMF and periareolar groups, respectively, with no difference when classified according to BMI level (P = 0.069).…”

“…Over recent years, nipple-sparing mastectomy (NSM) has become a popular option for the surgical management of early-stage breast cancer, even for nontraditional indications, and for prophylactic mastectomy, facilitating immediate breast reconstruction and improving aesthetic outcome and patient satisfaction. 1–5 However, the profile of complications with NSM tends to be more complex compared with conventional mastectomy, with the choice of incision being a factor that can affect the complication rate and also the final aesthetic outcome. 6–9…”

“…Over recent years, nipple-sparing mastectomy (NSM) has become a popular option for the surgical management of early-stage breast cancer, even for nontraditional indications, and for prophylactic mastectomy, facilitating immediate breast reconstruction and improving aesthetic outcome and patient satisfaction. [1][2][3][4][5] However, the profile of complications with NSM tends to be more complex compared with conventional mastectomy, with the choice of incision being a factor that can affect the complication rate and also the final aesthetic outcome. [6][7][8][9] Lateral radial incisions, historically used in NSM, can facilitate surgery, allowing better access to the axilla; however, a visible scar and the possibility of nipple-areolar complex (NAC) malposition can affect the final aesthetic outcome.…”