Systematic review of therapeutic nipple‐sparingversusskin‐sparing mastectomy

Abstract

Background The use of nipple‐sparing mastectomy (NSM) is increasing, despite unproven oncological safety in the therapeutic setting. The aim of this systematic review was to determine the safety and efficacy of NSM compared with skin‐sparing mastectomy (SSM). Methods A literature search of all original studies including RCTs, cohort studies and case–control studies comparing women undergoing therapeutic NSM or SSM for breast cancer was undertaken. Primary outcomes were oncological outcomes; secondary outcomes were clinical, aesthetic, patient‐reported and quality‐of‐life outcomes. Data analysis was undertaken to explore the relationship between NSM and SSM, and preselected outcomes. Heterogeneity was assessed using the Cochrane tests. Results A total of 690 articles were identified, of which 14 were included. There was no statistically significant difference in 5‐year disease‐free survival and mortality for NSM and SSM groups, where data were available. Local recurrence rates were also similar for NSM and SSM (3·9 versus 3·3 per cent respectively; P = 0·45). NSM had a partial or complete nipple necrosis rate of 15·0 per cent, and a higher complication rate than SSM (22·6 versus 14·0 per cent respectively). The higher overall complication rate was due to the rate of nipple necrosis in the NSM group (15·0 per cent). Conclusion In carefully selected cases, NSM is a viable choice for women with breast cancer who need to have a mastectomy. More research is needed to help further refine which surgical approaches to NSM optimize outcomes.

Implant Reconstruction in Nipple Sparing Mastectomy

“…62 In their 2018 systematic review comparing 1,419 NSMs to 1,596 SSMs, Agha et al also reported no statistical difference between these procedures with regard to both mortality and local recurrence. 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.…”

Can we safely accommodate larger volume implants in inframammary fold nipple sparing mastectomy compared to nipple sacrificing mastectomy in implant-based reconstruction with acellular dermal matrix?

“…Meta-analysis has shown that it is oncologically safe to preserve the nipple during mastectomy. 8 For aesthetic reasons Nipple sparing mastectomy has become the operation of choice both in the risk reduction setting and in cancer cases where surgeon is confident to get a clear margin. However, nipple sparing mastectomy has resulted in increased complications mainly due to nipple necrosis as shown in the systematic review.…”

“…However, nipple sparing mastectomy has resulted in increased complications mainly due to nipple necrosis as shown in the systematic review. 8 This could be due to operations involving incisions around the nipple and mastectomy flap which may compromise the blood supply leading to increased ischemic complications. This may also be the case in nipple sacrificing mastectomy where you excise the nipple during mastectomy.…”

An alternative method to create a breast mound after tissue expander insertion: The modified Goldilocks technique

“…However, rolling up the expanded skin for tissue supplementation to create a breast mound may raise concerns about oncologic safety. However, there is no need to worry about cancer recurrence in the skin that remains post-mastectomy, as the oncologic safety of nipple-areolar skin-sparing mastectomy has been proven and widely accepted [13][14][15]. If a general surgeon performs mastectomy and confirms that the resection margins are free of cancer, this technique may be considered safe on the basis of the evidence to date.…”