Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer

Abstract

IMPORTANCE The main concern associated with nipple-sparing mastectomy (NSM) is the risk of local breast cancer recurrence at the retained nipple-areola complex (NAC) consequent to occult nipple involvement. Long-term follow-up data regarding the oncologic safety of modern therapeutic NSM in terms of cancer recurrence at the NAC and survival are limited. OBJECTIVE To assess the incidence, risk factors, treatment, and long-term outcomes associated with cancer recurrence at the NAC in a large series of patients with invasive breast cancer who underwent NSM and immediate breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study at a single institution (Asan Medical Center) in Seoul, Republic of Korea, 962 breasts from 944 patients who underwent NSM and immediate breast reconstruction for invasive breast cancer were analyzed between March 3, 2003, and December 31, 2015. Patients who underwent neoadjuvant systemic therapy or palliative surgery were excluded. Data analysis was performed from June 4, 2018, to August 31, 2018. MAIN OUTCOMES AND MEASURES Univariate and multivariate Cox proportional hazards regression models were used to analyze the association between clinicopathologic variables and cancer recurrence at the NAC. To evaluate the association between cancer recurrence at the NAC and prognosis, distant metastasis-free survival, and overall survival were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Among the 944 study patients (median age at diagnosis, 43 years [range, 23-67 years]) during a median follow-up of 85 months (range, 14-185 months), 39 cases (4.1%) of cancer recurrence at the NAC were identified as the first event after NSM. The 5-year cumulative incidence of cancer recurrence at the NAC was 3.5% (n = 34). In multivariate analyses, multifocality or multicentricity (hazard ratio [HR], 3.309; 95% CI, 1.501-7.294; P = .003), negative hormone receptor or ERBB2 (formerly HER2 or HER2/neu)-positive subtype (HR, 3.051; 95% CI, 1.194-7.796; P = .02), high histologic grade (HR, 2.641; 95% CI, 1.132-6.160; P = .03), and extensive intraductal component (HR, 3.338; 95% CI, 1.262-8.824; P = .02) were independently associated with cancer recurrence at the NAC after NSM. All 39 recurrent cases involved wide local excision. Patients with and without cancer recurrence at the NAC as the first event did not differ significantly with regard to distant metastasis-free survival (P = .95) or overall survival (P = .21). The 10-year distant metastasis-free survival rates were 89.3% among patients with cancer recurrence at the NAC and 94.3% among patients without recurrence. The 10-year overall survival rates were 100% among patients with cancer recurrence at the NAC and 94.5% among those without recurrence. CONCLUSIONS AND RELEVANCE Patients had a low incidence of cancer recurrence at the NAC after NSM and immediate breast reconstruction in this study. The findings suggest that multifocal or multicentric disease, hormone receptor-negative/ERBB2-posit...

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

“…In nine studies, stages 0-I, II, and III were reported in 51.7%, 38.9%, and 9.4% of the cases, respectively (21,24,25,27,29,31,33,35,36). In five studies that reported T-stage, T1, T2, and T3 tumors were in 60.2%, 35.2%, and 4.4% of the cases, respectively (22,26,28,37,38). N0, N1, and N2 disease was reported in 65.1%, 24.8%, and 10% of the patients, respectively (26,28,37,38).…”

“…A total of 457 publications were identified through PubMed and CENTRAL search using the keywords, of which 19 were eligible for inclusion in the final analysis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The PRISMA flow chart is presented in Figure 1.…”

Investigation of the current situation of nipple-sparing mastectomy: a large multicenter study in China (CSBrs-003)

“…), 61% had NAC involvement. [ 20 ] These findings are considered contraindications to NSM in most literature. Although no patients with nipple discharge had recurrence and metastasis in this study, the relationship between nipple discharge and NSM surgery could not be obtained due to the short follow-up time.…”

Mastectomy with immediate breast reconstruction: Results of a mono-centric 4-years cohort

“…Otherwise, quality of life and cosmetic outcomes seems to be similar between BCS and IBR [ 23 ]. NSM with IBR is considered as a valid procedure for prophylactic mastectomy and an acceptable option for BC [ [24] , [25] , [26] , [27] ]. Consequently, the demand of NSM by patients and the propositions of NSM by surgeons increased [ 28 , 29 ].…”