The Role of Nipple-Sparing Mastectomy in Breast Cancer

Mallon, Peter; Féron, Jean-Guillaume; Couturaud, Benoît; Fitoussi, A.; Lemasurier, Perig; Guihard, T.; Cothier-Savay, Isabelle; Reyal, Fabien

doi:10.1097/prs.0b013e3182865a3c

Cited by 151 publications

(116 citation statements)

References 57 publications

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“…The circumareolar approach was replaced by the lateral radial or inframammary incisions, as there was significantly less loss of the NAC when the incision did not involve the NAC. This has been demonstrated by numerous other studies (28,34,37). In a 2014 retrospective review of 500 NSMs, patients with incisions encompassing the NAC had a complication rate of 21.1% compared to 8.5% when the inframammary incision was used (31).…”

Section: Discussionsupporting

confidence: 66%

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Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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Abstract. Nipple-sparing mastectomies (NSMs) are increasingly used in the surgical treatment of patients with breast cancer and for prevention of breast cancer. The present study was performed to review the outcomes of patients undergoing NSMs at a single large university setting. A retrospective chart review was performed on all patients undergoing NSMs from 2008-2014. Charts were reviewed for demographic data and patient characteristics. Tumor and breast size, cancer recurrence and complications were also evaluated. Descriptive statistics were utilized to summarize the findings. From 2008From -2014 NSMs. The mean patient age was 44.4 years (range, 20-77). The average body mass index was 24 (range, 18-47). Breast weight was available for 106 specimens, with a mean weight of 475.5 g (range, 124.1-1,625.0 g). Seventy-three NSMs were performed for cancer and 124 were performed prophylactically. The mean tumor width was 1.38 cm (range, 0-6.0 cm), with an average nipple to tumor distance of 5.87 cm (range, 2.93-10.0 cm). Three (4%) patients required removal of the nipple areolar complex (NAC) due to pathological extension of the tumor. A total of 34 (17.2%) complications occurred, including infections, hematomas and nipple necrosis, with 9 requiring removal of the NAC and 13 requiring removal of the tissue expander or implant. Smokers had a 36.0% (9/25) complication rate, compared with 14.5% (25/172) of nonsmokers (P<0.05). During follow-up, one recurrence was noted, located on the chest wall. There were no recurrences in the NAC group. Therefore, NSMs may safely be performed without compromising oncologic outcomes or increasing complication rates in properly selected patients.

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Section: Discussionsupporting

confidence: 66%

“…In order to decrease the likelihood of cancer involvement of the NAC, numerous studies have recommended that the tumor to NAC distance on pre-operative imaging be no closer than 2 cm (23,(26)(27)(28). Tumors found to be closer than 2 cm to the NAC are considered to be a relative contraindication to pursuing NSM.…”

Section: Discussionmentioning

confidence: 99%

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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“…121,122 Contraindications for nipple preservation include evidence of nipple involvement, such as Paget disease or bloody nipple discharge. Several prospective trials are underway to evaluate NAC-sparing mastectomy in the setting of cancer, and enrollment in such trials is encouraged.…”

Section: Breast Reconstructionmentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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“…In 11 studies, the inclusion criterion for NSM was small tumors >1-2 cm distant from the NAC (1,33). In 21 studies, locally advanced and multi-centric tumors were included (4,34,35).…”

Section: Indications Of Nsmmentioning

confidence: 99%

“…In ~25% of breast cancer patients, a mastectomy is indicated for multi-centric or large tumors, and for local recurrence following BCT (1). Radical mastectomy is disfiguring, with removal of all the skin, the sub-mammarial fold and the nipple-areola complex (NAC).…”

Section: Introductionmentioning

confidence: 99%

Nipple-sparing mastectomy in breast cancer patients: The role of adjuvant radiotherapy (Review)

et al. 2015

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Abstract. The present study aimed to evaluate the role of adjuvant radiotherapy (RT) following nipple-sparing mastectomy (NSM) for patients with ductal carcinoma in situ and invasive breast cancer, based on the published literature. Currently, there is no standard for RT following NSM. NSM aims to spare the nipple areola complex (NAC) without compromising locoregional control. Long-term follow-up studies have begun to show promising results. A search of the English literature was performed using the Medline database and Cochrane central library, with the keywords 'nipple/areola-sparing mastectomy', 'whole skin mastectomy' and 'NAC preservation'. A total of 32 original studies with data on NSM in terms of locoregional control, NAC control, NAC necrosis and adjuvant RT were identified. The median locoregional and NAC recurrence rates were 3.2 and 1.4% (range, 0-28.4% and 0-3.7%), respectively. The volume of remaining breast tissue following NSM was reported inconsistently. In 15 studies, RT was not mentioned. In the remaining 17 studies, RT was administered in 0-100% of patients. Only 7 studies provided detailed information regarding the use of adjuvant RT. Adjuvant thoracic wall irradiation was not used in certain studies, not even for locoregionally advanced tumors. Overall, NSM appears a feasible treatment without increased risk of locoregional recurrence for selected patients. The role of adjuvant RT following NSM requires further clarification. The decision regarding adjuvant RT must be made in interdisciplinary tumor boards and with consideration of the individual situation of the patient.

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The Role of Nipple-Sparing Mastectomy in Breast Cancer

Cited by 151 publications

References 57 publications

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Breast Cancer Version 3.2014

Nipple-sparing mastectomy in breast cancer patients: The role of adjuvant radiotherapy (Review)

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