Oncologic safety of nipple‐sparing mastectomy in patients with short tumor‐nipple distance

Abstract

Background There is a tendency to avoid nipple‐sparing mastectomy (NSM) when a tumor‐nipple distance (TND) is <2 cm due to the risk of occult nipple involvement. The purpose of the study was to determine whether the patients who undergo NSM with immediate reconstruction are oncologically safe when TND is <2 cm. Methods Patients who underwent NSM followed by immediate reconstruction for breast cancer were retrospectively analyzed. Patients who are negative for nipple‐base in either frozen‐section or paraffin histopathology were included. MRI was used to obtain TNDs to compare local‐recurrence‐free and disease‐free survival in group I (TND <2 cm) and group II (TND ≥2 cm). Disease‐free survival rates were determined to assess the outcome. Results Of the 214 cases with malignancy on MRI, 21 cases diagnosed with pure ductal carcinoma in situ were excluded. Among the 193 NSM cases diagnosed with invasive cancer, TND was <2.0 cm in 59 (30.56%) cases and ≥2.0 cm in 134 (69.43%) cases. No significant differences were found between groups in regards to ER, PR, HER2‐neu status, and nodal involvement (P = 0.34, P = 0.41, P = 0.54, and P = 0.12 respectively). In a median follow‐up time of 62 months (range; 13‐114), patients in group I had four local recurrences, whereas group II was found to have five local and three distant metastases. No significant differences were observed between groups concerning disease‐free survival (10‐year DFS 93.2% vs 96.3%; P = 0.368 respectively). Conclusions Patients who have invasive cancer diagnosis with a TND <2 cm are eligible to undergo therapeutic NSM with immediate reconstruction.

Implant Reconstruction in Nipple Sparing Mastectomy

“…63 In a retrospective 2019 study, with a mean follow-up time of 62 months, investigating patients who underwent therapeutic NSM followed by immediate reconstruction, 59 patients (tumor-to-nipple distance of < 2.0 cm) were compared with 134 patients (tumor-to-nipple distance of > 2.0 cm). 64 There were no significant differences found between these groups with respect to ER, PR, HER2-neu status, or nodal involvement. The 10-year disease-free survival was 93.2% in the < 2.0 cm group and 96.3% in the > 2.0 cm group, with no statistically significant difference shown (p ¼ 0.368).…”

“…The 10-year disease-free survival was 93.2% in the < 2.0 cm group and 96.3% in the > 2.0 cm group, with no statistically significant difference shown (p ¼ 0.368). 64 Collectively, these studies indicate that NSM reconstruction in well-selected patients is an oncologically sound procedure compared with other mastectomy techniques.…”

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

“…In our study, the other factors that increased the risk of NAC necrosis were short TND and large breast weight. TND has been a main concern with respect to oncologic safety in NSM, and several studies have reported the feasibility of NSM in patients with a short TND [ [28] , [29] , [30] , [31] ]. However, few papers have investigated the correlation between TND and nipple necrosis.…”

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

“…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.…”