This study aimed to analyze our 11-year experience using NSM with immediate breast reconstruction in breast cancer.
Between January 2007 and December 2015, 251 NSMs were performed on 251 women with breast cancer for therapeutic purpose at Pusan National University Hospital.
The clinical and pathologic mean tumor size was 3.1 cm. Based on preoperative imaging, mean distance between tumor and nipple was 2.5 cm. Among 251 tumors, 119 cases (47.4%) and 69 cases (27.5%) with a distances ≤ 2 cm and ≤ 1 cm, respectively, were detected. There were 11 patients (4.4%) with locoregional recurrences during the mean follow-up period of 68.0 months. Of these 11 cases, one (0.4%) had local recurrence in the retained NAC, and the others had recurrence in the chest wall or skin.
Unless clinical and histological evidence of nipple involvement, NSM can be an oncologically safe surgical option for breast cancer, even if the tumor is located close to the nipple.
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De La Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol. 2015;22:3241–9.
Peled AW, Wang F, Foster RD, Alvarado M, Ewing CA, Sbitany H, et al. Expanding the indications for total skin-sparing mastectomy: Is it safe for patients with locally advanced disease? Ann Surg Oncol. 2016;23:87–91.
Seki T, Jinno H, Okabayashi K, Murata T, Matsumoto A, Takahashi M, et al. Comparison of oncological safety between nipple sparing mastectomy and total mastectomy using propensity score matching. Ann R Coll Surg Engl. 2015;97:291–7.
Spear SL, Shuck J, Hannan L, Albino F, Patel KM. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg. 2014;133:605e–e614614.
Burdge EC, Yuen J, Hardee M, Gadgil PV, Das C, Henry-Tillman R, et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol. 2013;20:3294–302.
Adam H, Bygdeson M, de Boniface J. The oncological safety of nipple-sparing mastectomy—a Swedish matched cohort study. Eur J Surg Oncol. 2014;40:1209–15.
Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, et al. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single-center study at a Japanese institution. Med Oncol. 2013;30:481.
Stanec Z, Zic R, Budi S, Stanec S, Milanović R, Vlajčić Z, et al. Skin and nipple–areola complex-sparing mastectomy in breast cancer patients: 15-year experience. Ann Plast Surg. 2014;73:485–91.
Canavan J, Truong PT, Smith SL, Lu L, Lesperance M, Olivotto IA. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys. 2014;88:80–6.
Wapnir I, Dua M, Kieryn A, Paro J, Morrison D, Kahn D, et al. Intraoperative imaging of nipple perfusion patterns and ischemic complications in nipplesparing mastectomies. Ann Surg Oncol. 2014;21:100–6.
de Alcantara FP, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–222.
Coopey SB, Tang R, Lei L, Freer PE, Kansal K, Colwell AS, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–22.
Wang F, Peled AW, Garwood E, Fiscalini AS, Sbitany H, Foster RD, et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21:3223–300.
Poruk KE, Ying J, Chidester JR, Olson JR, Matsen CB, Neumayer L, et al. Breast cancer recurrence after nipple-sparing mastectomy: one institution’s experience. Am J Surg. 2015;209:212–7.
Alperovich M, Choi M, Frey JD, Lee ZH, Levine JP, Saadeh PB, et al. Nipple-sparing mastectomy in patients with prior breast irradiation: Are patients at higher risk for reconstructive complications? Plast Reconstr Surg. 2014;134:202e–e206206.
Tanna N, Broer PN, Weichman KE, Alperovich M, Ahn CY, Allen RJ Sr, et al. Microsurgical breast reconstruction for nipple-sparing mastectomy. Plast Reconstr Surg. 2013;131:139e–e147147.
Shons AR, Press BH. Subcutaneous mastectomy: indications, technique, and applications. Arch Surg. 1983;118:844–50.
Yugueros P, Bite U. Current concepts and techniques in subcutaneous mastectomy. Oper Tech Gen Surg. 2000;2:110–7.
Cunnick GH, Mokbel K. Skin-sparing mastectomy. Am J Surg. 2004;188:78–84.
Krajewski AC, Boughey JC, Degnim AC, Jakub JW, Jacobson SR, Hoskin TL, et al. Expanded indications and improved outcomes for nipple-sparing mastectomy over time. Ann Surg Oncol. 2015;22:3317–23.
Freeman BS. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast Reconstr Surg. 1962;30:676–82.
Margulies AG, Hochberg J, Kepple J, Henry-Tillman RS, Westbrook K, Klimberg VS. Total skin-sparing mastectomy without preservation of the nipple–areolar complex. Am J Surg. 2005;190:907–12.
Crowe JP Jr, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg. 2004;139:148–50.
Caruso F, Ferrara M, Castiglione G, Trombetta G, De Meo L, Catanuto G, et al. Nipple-sparing subcutaneous mastectomy: sixty-six months follow-up. Eur J Surg Oncol. 2006;32:937–40.
Jensen JA, Orringer JS, Giuliano AE. Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol. 2011;18:1665–700.
Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203:704–14.
Petit JY, Veronesi U, Orecchia R, Curigliano G, Rey PC, Botteri E, et al. Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia. Ann Oncol. 2012;23:2053–8.
Alperovich M, Choi M, Karp NS, Singh B, Ayo D, Frey JD, et al. Nipple-sparing mastectomy and sub-areolar biopsy: to freeze or not to freeze? Evaluating the role of sub-areolar intraoperative frozen section. Breast J. 2016;22:18–23.
Agarwal JP, Mendenhall SD, Anderson LA, Ying J, Boucher KM, Liu T, et al. The breast reconstruction evaluation of acellular dermal matrix as a sling trial (BREASTrial): design and methods of a prospective randomized trial. Plast Reconstr Surg. 2015;135:20e–e2828.
Gabos Z, Thoms J, Ghosh S, Hanson J, Deschênes J, Sabri S, et al. The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer. Breast Cancer Res Treat. 2010;124:187–94.
Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong YN, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. 2012;118:5463–72.
Byon W, Kim E, Kwon J, Park YL, Park C. Magnetic resonance imaging and clinicopathological factors for the detection of occult nipple involvement in breast cancer patients. J Breast Cancer. 2014;17:386–92.
Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol. 2001;27:521–6.
Gerber B, Krause A, Reimer T, Müller H, Küchenmeister I, Makovitzky J, et al. Skin-sparing mastectomy with conservation of the nipple–areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–7.
Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE. The incidence of occult nipple–areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol. 1999;6:609–13.
Demicheli R, Biganzoli E, Ardoino I, Boracchi P, Coradini D, Greco M, et al. Recurrence and mortality dynamics for breast cancer patients undergoing mastectomy according to estrogen receptor status: different mortality but similar recurrence. Cancer Sci. 2010;101:826–30.
Song WJ, Kim KI, Park SH, Kwon MS, Lee TH, Park HK, et al. The risk factors influencing between the early and late recurrence in systemic recurrent breast cancer. J Breast Cancer. 2012;15:218–23.
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Kim, S., Lee, S., Bae, Y. et al. Nipple-sparing mastectomy for breast cancer close to the nipple: a single institution’s 11-year experience. Breast Cancer 27, 999–1006 (2020). https://doi.org/10.1007/s12282-020-01104-0
- Nipple-sparing mastectomy
- Oncologic safety
- Tumor-to-nipple distance
- Tumor size