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

Abstract

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.

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

“…However, NAC and skin flap ischemia and necrosis can occur and result in morbidity to the patient. Previous studies have reported various patient, clinical, and surgical factors, such as age, smoking history, and type of surgical incision, that are associated with ischemic and necrotic complications after NSM (2,9,14,15,19,21,22). Our study is unique in that it addresses vascular features on pre-operative MRI that are predictive of ischemic and necrotic complications.…”

“…Several factors associated with NAC and skin flap ischemia and necrosis have been reported, including age, body mass index (BMI), smoking history, hypertension/diabetes mellitus, pre-operative radiation therapy, oncologic indication for NSM, breast volume, type of incision, reconstruction approach, and NAC involvement with areola flap thickness less than 5 mm (2,9,14,15,19,21,22,25). To our knowledge, however, there are no published studies on the vascular supply to the breast, as characterized by pre-operative MRI, and its association with NAC and skin flap ischemia and necrosis.…”

“…Despite long-term oncologic safety and generally excellent cosmesis with breast conserving surgery, approximately 20% to 30% of women with breast cancer undergo mastectomy (1)(2)(3)(4)(5). Nipple-sparing mastectomy (NSM), which has emerged as an alternative to standard mastectomy, is felt to be oncologically safe, provides cosmetic and quality-of-life benefits for patients, and results in a reduced need for additional nipple reconstruction procedures (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Postoperative radiotherapy after nipple- or skin-sparing mastectomy: a review of recent institutional and pooled data

“…Out of 17 studies analysed by Janssen et al [ 29 ] in 2015, only seven provided a detailed description of the radiotherapy modalities. In most studies, the delivered dose was 50 Gy.…”

Considerations arising from requests from patients for a bilateral mastectomy who are eligible for breast-conserving surgery: Factors weighing for and against performing the operation

“…In addition, rates of CPM are also on the rise for both invasive and in situ cancer (1,6,7). There are several reasons for these phenomena, including the increasing use of preoperative MRI, the growing employment of immediate post-mastectomy reconstruction, improvements in cosmetic results with the relatively new techniques of skin-and nipple-sparing mastectomy, the increasing use of genetic testing, and last but not least, the patients' entitlement to choose their preferred surgery option (6)(7)(8)(9)(10)(11)(12).…”