Low breast cancer recurrence after nipple-sparing mastectomy

By Liz Meszaros, MDLinx
Published July 23, 2017

Key Takeaways

In breast cancer patients, locoregional and distant cancer recurrence are low following nipple-sparing mastectomy (NSM), and no recurrences involved the retained nipple areola complex, according to results from a study published online first in the Journal of the American College of Surgeons.

Although NSM has gained popularity for the treatment and prevention of breast cancer, limited data exist about its long-term oncologic safety.

"More women are requesting NSM because of the superior cosmetic results, but doctors don't want to take any chances with breast cancer patients' safety for the sake of cosmetic improvement," said principal investigator Barbara L. Smith, MD, PhD, FACS, surgical oncologist and director of the Breast Program, Massachusetts General Hospital, Boston, MA. "Our study, which has one of the longest reported follow-ups after therapeutic NSM in the United States, provides additional support that it's safe to leave the nipple intact during mastectomy with only a few exceptions."

Dr. Smith and her colleagues conducted this review, therefore, to assess oncologic outcomes of consecutive therapeutic NSM at Massachusetts General Hospital, where NSM is offered to patients with no radiologic or clinical evidence of nipple involvement.

Between 2007 and 2016, 2,182 NSMs were performed, and of these, researchers assessed long-term outcomes in 311 performed in 2007 to 2012 for stage 0-3 breast cancers (77% for invasive cancers, 23% for ductal carcinoma in situ).

At a median follow-up of 51 months, 17 patients developed cancer recurrence. At 3 years, estimated disease-free survival was 95.7%, and at 5 years, 92.3%.

In all, locoregional recurrences occurred in 3.7%, and distant recurrences in 2.7%. Two patients had simultaneous locoregional and distant recurrences. Among patients with isolated distant recurrences, two died of cancer-related causes. No patients in the entire cohort has experienced a recurrence in the retained nipple-areola complex.

"Often, a woman feels more whole when she keeps her nipple," Dr. Smith said. "Not only does the breast look more natural after NSM, a woman who still has fully intact breast skin can often choose to have a single-stage breast reconstruction with an implant, rather than needing a tissue expander (an inflatable breast implant) to stretch the skin over several months."

At the Massachusetts General Breast Program, explained Dr. Smith, patient selection criteria have been expanded. Women with breast cancer are candidates for NSM unless they have any of the following:

  • clinical or imaging evidence of cancerous involvement of the nipple and areola;
  • locally advanced breast cancer involving the skin;
  • inflammatory breast cancer; or
  • very large or sagging breasts, which would result in an unacceptable location of the nipple.

"Women planning a mastectomy should ask their surgeon whether they are eligible for a nipple-sparing operation," concluded Dr. Smith.

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