Long-Term Cancer Recurrence Rates following Nipple-Sparing Mastectomy: A 10-Year Follow-Up Study

Boyd, Carter J.; Salibian, Ara A.; Bekisz, Jonathan M.; Axelrod, Deborah; Guth, Amber A.; Shapiro, Richard L.; Schnabel, Freya; Karp, Nolan S.; Choi, Mihye

doi:10.1097/prs.0000000000009495

Cited by 5 publications

(6 citation statements)

References 27 publications

(48 reference statements)

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“…26,27 Furthermore, patients with NSM have been followed across time and have demonstrated low rates of oncologic occurrence or recurrence. [28][29][30][31] Nipple-areolar complex necrosis is a rare, but dreaded, complication after NSM as it undermines the core objective of the "nipplesparing" mastectomy. The prevalence of ischemic complications affecting the NAC ranges from less than 1% to 18% after NSM.…”

Section: Discussionmentioning

confidence: 99%

Minimizing Nipple-Areolar Complex Complications in Prepectoral Breast Reconstruction After Nipple-Sparing Mastectomy

Perez-Otero,

Hemal,

Boyd

et al. 2024

Ann Plast Surg

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Purpose Nipple-areolar complex (NAC) viability remains a significant concern following prepectoral tissue expander (TE) reconstruction after nipple-sparing mastectomy (NSM). This study assesses the impact of intraoperative TE fill on NAC necrosis and identifies strategies for mitigating this risk. Methods A chart review of all consecutive, prepectoral TEs placed immediately after NSM was performed between March 2017 and December 2022 at a single center. Demographics, mastectomy weight, intraoperative TE fill, and complications were extracted for all patients. Partial NAC necrosis was defined as any thickness of skin loss including part of the NAC, whereas total NAC necrosis was defined as full-thickness skin loss involving the entirety of the NAC. P < 0.05 was considered statistically significant. Results Forty-six patients (83 breasts) with an average follow-up of 22 months were included. Women were on average 46 years old, nonsmoker (98%), and nondiabetic (100%) and had a body mass index of 23 kg/m2. All reconstructions were performed immediately following prophylactic mastectomies in 49% and therapeutic mastectomies in 51% of cases. Three breasts (4%) were radiated, and 15 patients (33%) received chemotherapy. Mean mastectomy weight was 346 ± 274 g, median intraoperative TE fill was 150 ± 225 mL, and median final TE fill was 350 ± 170 mL. Partial NAC necrosis occurred in 7 breasts (8%), and there were zero instances of complete NAC necrosis. On univariate analysis, partial NAC necrosis was not associated with any patient demographic or operative characteristics, including intraoperative TE fill. In multivariable models controlling for age, body mass index, mastectomy weight, prior breast surgery, and intraoperative TE fill, partial NAC necrosis was associated with lower body mass index (odds ratio, 0.53; confidence interval [CI], 0.29–0.98; P < 0.05) and higher mastectomy weight (odds ratio, 1.1; CI, 1.01–1.20; P < 0.05). Prior breast surgery approached significance, as those breasts had a 19.4 times higher odds of partial NAC necrosis (95% CI, 0.88–427.6; P = 0.06). Conclusions Nipple-areolar complex necrosis following prepectoral TE reconstruction is a rare but serious complication. In this study of 83 breasts, 7 (8%) developed partial NAC necrosis, and all but one were able to be salvaged.

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Section: Discussionmentioning

confidence: 99%

Minimizing Nipple-Areolar Complex Complications in Prepectoral Breast Reconstruction After Nipple-Sparing Mastectomy

Perez-Otero,

Hemal,

Boyd

et al. 2024

Ann Plast Surg

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“…We hypothesized in this distinct analysis that patients at this follow-up interval would have a low incidence of oncologic occurrence following NSM. 25 Nonetheless, it is important to continue to counsel patients on the possibility of cancer occurrence after prophylactic mastectomy, especially in high-risk populations. Evidence for clinical surveillance after therapeutic mastectomy in patients with breast cancer is well established; at our institution, patients with cancer are recommended to follow-up with the breast surgeon every 6 months for 3 to 5 years after surgery, followed by annual examinations in perpetuity.…”

Section: Discussionmentioning

confidence: 99%

Low Cancer Occurrence Rate following Prophylactic Nipple-Sparing Mastectomy

Boyd

Ramesh

Bekisz³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Nipple-sparing mastectomy (NSM) has become widely available for breast cancer prophylaxis. There are limited data on its long-term oncologic safety. The objective of this study was to determine the incidence of breast cancer in patients who underwent prophylactic NSM. Methods: All patients undergoing prophylactic NSM at a single institution from 2006 through 2019 were retrospectively reviewed. Patient demographic factors, genetic predispositions, mastectomy specimen pathology, and oncologic occurrences at follow-up were recorded. Descriptive statistics were performed where necessary to classify demographic factors and oncologic characteristics. Results: A total of 871 prophylactic NSMs were performed on 641 patients, with median follow-up of 82.0 months (standard error 1.24). A total of 94.4% of patients (n = 605) underwent bilateral NSMs, although only the prophylactic mastectomy was considered. The majority of mastectomy specimens (69.6%) had no identifiable pathology. A total of 38 specimens (4.4%) had cancer identified in mastectomy specimens, with ductal carcinoma in situ being the most common (92.1%; n = 35). Multifocal or multicentric disease was observed in seven cases (18.4%) and lymphovascular invasion was identified in two (5.3%). One patient (0.16%), who was a BRCA2 variant carrier, was found to have breast cancer 6.5 years after prophylactic mastectomy. Conclusions: Overall primary oncologic occurrence rates are very low in high-risk patients undergoing prophylactic NSM. In addition to reducing the risk of oncologic occurrence, prophylactic surgery itself may be therapeutic in a small proportion of patients. Continued surveillance for these patients remains important to assess at longer follow-up intervals. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.

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“…The discovery that the duct bundle could be removed from the nipple while preserving the blood supply led to the current era of nipple-sparing mastectomy. In this special edition, Carter et al, 1 from New York University, show a low risk of cancer recurrence in patients undergoing nipple-sparing mastectomy and followed up for a median period of 10 years, supporting this practice advancement.…”

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confidence: 83%