Oncologic Safety of Nipple Skin-Sparing or Total Skin-Sparing Mastectomies With Immediate Reconstruction

Boneti, Cristiano; Yuen, James C.; Santiago, Carlos; Diaz, Zuleika; Robertson, Yara; Korourian, Soheila; Westbrook, Kent C.; Henry‐Tillman, Ronda; Klimberg, V. Suzanne

doi:10.1016/j.jamcollsurg.2010.12.039

Cited by 148 publications

(120 citation statements)

References 36 publications

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“…Sakurai et al reported a study of 788 patients without adjuvant RT following NSM in Union for International Cancer Control stage 0-IV patients (38). The locoregional recurrence rate of 8.2% and the NAC recurrence rate of 3.7% were comparable to the rates of other studies (Table 1) Burdge et al (34) and Boneti et al (25) delivered 50 Gy to the thoracic wall (with or without lymphatic drainage) for tumors >5 cm and/or in cases with ≥4 positive lymph nodes.…”

Section: Adjuvant Rtmentioning

confidence: 60%

“…Other studies confirmed these good cosmetic outcomes (25,27,28). Petit et al (29) achieved a global result of 8/10, as rated by patients and surgeons, respectively, following ELIOT.…”

Section: Cosmesismentioning

confidence: 65%

“…The outcomes were not significantly different between the patients receiving ELIOT (n=800) and those receiving delayed post-operative RT (n=201) (29). In six other studies providing statements on RT, a dose of 50 Gy was applied to the thoracic wall using conventional fractionation, with daily doses of 2 Gy administered on 5 days per week (13,14,18,25,28,34). In the study by Rulli et al, the decision for adjuvant RT was based on the remaining breast tissue, with residual glandular tissue as an indication for RT (n=10) and no remaining tissue after NSM as an indication for withholding RT (n=50) (18).…”

Section: Adjuvant Rtmentioning

confidence: 99%

“…Almost all studies identified used intraoperative pathological assessment (frozen sections) of the subareolar tissue for deciding whether NSM could be carried out or not. In cases of involvement of the NAC, the complex was not spared (25,29,33).…”

Section: Indications Of Nsmmentioning

confidence: 99%

“…The indications of NSM have been extended from a prophylactic scenario and small tumors distant from the NAC to larger and multi-centric tumors (4,5). There are several studies and reviews on NSM (1,2,5-10), a number of which focus on oncological safety (3,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), cosmetic outcome (24)(25)(26)(27)(28)(29) and surgical techniques (24)(25)(26)(27)(28)(29)(30)(31)(32). The role of adjuvant radiotherapy (RT), including dose-fractionation concepts and techniques (6), remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Adjuvant Rtmentioning

confidence: 60%

“…Other studies confirmed these good cosmetic outcomes (25,27,28). Petit et al (29) achieved a global result of 8/10, as rated by patients and surgeons, respectively, following ELIOT.…”

Section: Cosmesismentioning

confidence: 65%

Section: Adjuvant Rtmentioning

confidence: 99%

Section: Indications Of Nsmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Nipple- and areola-sparing mastectomy for the treatment of breast cancer

Mota

Riera

Ricci

et al. 2016

Cochrane Database of Systematic Reviews

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Background The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. Objectives To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. Search methods We searched the Cochrane Breast Cancer Group’s Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms “nipple sparing mastectomy” and “areola-sparing mastectomy”. Also, we searched the World Health Organization’s International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. Selection criteria Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. Data collection and analysis Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane’s risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. Main results We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical mastectomy (MRM). No participants underwent areola-sparing mastectomy. There was a high risk of confounding for all reported outcomes. For overall survival, the hazard ratio (HR) for NSM compared to SSM was 0.70 (95% CI 0.28 to 1.73; 2 studies; 781 participants) and the HR for NSM compared to MRM was 0.72 (95% CI 0.46 to 1.13; 2 studies, 1202 participants). Local recurrence was evaluated in two studies, the HR for NSM compared to MRM was 0.28 (95% CI 0.12 to 0.68; 2 studies, 1303 participants). The overall risk of complications was different in NSM when compared to other types of mastectomy in general (RR 0.10, 95% CI 0.01 to 0.82, 2 studies, P = 0.03; 1067 participants). With respect to skin necrosis, there was no evidence of a difference with NSM compared to other types of mastectomy, but the confidence interval was wide (RR 4.22, 95% CI 0.59 to 30.03, P = 0.15; 4 studies, 1948 participants). We observed no difference among the three types of mastectomy ...

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International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Nava

Benson

Audretsch

et al. 2019

British Journal of Surgery

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Background Conflicting evidence challenges clinical decision‐making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer‐reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient‐informed consent. Low‐quality studies are conflicting with wide‐ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high‐quality evidence from prospective registries and randomized trials in this field.

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Oncologic Safety of Nipple Skin-Sparing or Total Skin-Sparing Mastectomies With Immediate Reconstruction

Cited by 148 publications

References 36 publications

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

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

Nipple- and areola-sparing mastectomy for the treatment of breast cancer

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

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