Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3194–3203 | Cite as

National Patterns of Breast Reconstruction and Nipple-Sparing Mastectomy for Breast Cancer, 2005–2015

  • Stephanie M. Wong
  • Yoon S. Chun
  • Yasuaki Sagara
  • Mehra Golshan
  • Jessica Erdmann-SagerEmail author
Breast Oncology



The purpose of this study was to explore national patterns in the uptake of breast reconstruction and nipple-sparing mastectomy (NSM).


We used the National Cancer Database to identify all women who underwent mastectomy for stage 0–III breast cancer between 2005–2015. Multivariable logistic regression was used to determine factors associated with receipt of reconstruction, with subset analyses performed to determine trends and predictors of NSM in those who underwent mastectomy with reconstruction.


Our cohort consisted of 395,815 women, 238,568 (60.3%) who underwent mastectomy alone and 157,247 (39.7%) who underwent mastectomy followed by reconstruction. The use of breast reconstruction increased from 22.3% of mastectomy cases in 2005 to 49.7% of mastectomy cases in 2015 (odds ratio [OR] 9.7, 95% confidence interval [CI] 7.3–12.8). Among those receiving reconstruction, the use of NSM increased from 1.7% in 2005 to 14.3% in 2015 (OR 9.4, 95% CI 7.1–12.5), with increased utilization among those with early-stage and locally advanced disease, such that by 2015, NSM was performed in 15.3% of mastectomies with reconstruction for DCIS, 14.3% of mastectomies with reconstruction for stage I–II breast cancer, and 10.7% of mastectomies with reconstruction for stage III breast cancer. Factors strongly predicting receipt of NSM included age < 45 years, smaller clinical tumor size, clinically node negative disease, use of neoadjuvant therapy, and facility type.


There has been a dramatic increase in the use of breast reconstruction and NSM between 2005–2015. Further prospective studies evaluating oncologic outcomes of NSM in locally advanced breast cancer are warranted.



The authors have no relevant conflict of interest to disclose.

Supplementary material

10434_2019_7554_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 40 kb)


  1. 1.
    Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118:623–33.CrossRefGoogle Scholar
  2. 2.
    Satteson ES, Brown BJ, Nahabedian MY. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis. Gland Surg. 2017;6:4–13.CrossRefGoogle Scholar
  3. 3.
    Wei CH, Scott AM, Price AN, et al. Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction. Breast J. 2016;22:10–7.CrossRefGoogle Scholar
  4. 4.
    Hartmann LC, Schaid DJ, Woods JE, et al: Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–84.CrossRefGoogle Scholar
  5. 5.
    Jakub JW, Peled AW, Gray RJ, et al. Oncologic safety of prophylactic nipple-sparing mastectomy in a population with BRCA mutations: a multi-institutional study. JAMA Surg. 2018;153:123–9.CrossRefGoogle Scholar
  6. 6.
    Mitchell SD, Willey SC, Beitsch P, et al. Evidence based outcomes of the American Society of Breast Surgeons Nipple Sparing Mastectomy Registry. Gland Surg. 2018;7:247–57.CrossRefGoogle Scholar
  7. 7.
    Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2009;114:97–101.CrossRefGoogle Scholar
  8. 8.
    Smith BL, Tang R, Rai U, et al. Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg. 2017;225:361–5.CrossRefGoogle Scholar
  9. 9.
    Yao K, Liederbach E, Tang R, et al. Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol. 2015;22:370–6.CrossRefGoogle Scholar
  10. 10.
    Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer Version 2.2015. J Natl Compr Canc Netw. 2015;13:448–75.Google Scholar
  11. 11.
    Burdge EC, Yuen J, Hardee M, et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol. 2013;20:3294–302.CrossRefGoogle Scholar
  12. 12.
    Peled AW, Wang F, Foster RD, 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.CrossRefGoogle Scholar
  13. 13.
    Weber WP, Haug M, Kurzeder C, et al. Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat. 2018;172:523–37.CrossRefGoogle Scholar
  14. 14.
    NCCN Guidelines Version 3.2018 Breast cancer. Published October 25, 2018. Accessed 11 Nov 2018.
  15. 15.
    Jonczyk MM, Jean J, Graham R, et al. Surgical trends in breast cancer: a rise in novel operative treatment options over a 12-year analysis. Breast Cancer Res Treat. 2019;173:267–74.CrossRefGoogle Scholar
  16. 16.
    Sisco M, Kyrillos AM, Lapin BR, et al. Trends and variation in the use of nipple-sparing mastectomy for breast cancer in the United States. Breast Cancer Res Treat. 2016;160:111–20.CrossRefGoogle Scholar
  17. 17.
    Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919–26.CrossRefGoogle Scholar
  18. 18.
    O’Halloran N, Lowery A, Kalinina O, et al. Trends in breast reconstruction practices in a specialized breast tertiary referral centre. BJS Open. 2017;1:148–57.CrossRefGoogle Scholar
  19. 19.
    Romanoff A, Zabor EC, Stempel M, et al. A comparison of patient-reported outcomes after nipple-sparing mastectomy and conventional mastectomy with reconstruction. Ann Surg Oncol. 2018;25:2909–16.CrossRefGoogle Scholar
  20. 20.
    Sisco M, Du H, Warner JP, et al. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national cancer data base. J Am Coll Surg. 2012;215:658–66; discussion 666.Google Scholar
  21. 21.
    Yang RL, Newman AS, Lin IC, et al. Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation. Cancer. 2013;119:2462–8.CrossRefGoogle Scholar
  22. 22.
    Epstein S, Tran BN, Cohen JB, et al. Racial disparities in postmastectomy breast reconstruction: National trends in utilization from 2005 to 2014. Cancer. 2018;124:2774–84.CrossRefGoogle Scholar
  23. 23.
    Schumacher JR, Taylor LJ, Tucholka JL, et al. Socioeconomic factors associated with post-mastectomy immediate reconstruction in a contemporary cohort of breast cancer survivors. Ann Surg Oncol. 2017;24:3017–23.CrossRefGoogle Scholar
  24. 24.
    Regis C, Le J, Chauvet MP, et al. Variations in the breast reconstruction rate in France: a nationwide study of 19,466 patients based on the French medico-administrative database. Breast. 2018;42:74–80.CrossRefGoogle Scholar
  25. 25.
    Retrouvey H, Solaja O, Gagliardi AR, et al. Barriers of access to breast reconstruction: a systematic review. Plast Reconstr Surg. 2019;143:465e–76e.CrossRefGoogle Scholar
  26. 26.
    Tang R, Coopey SB, Merrill AL, et al. Positive nipple margins in nipple-sparing mastectomies: rates, management, and oncologic safety. J Am Coll Surg. 2016;222:1149–55.CrossRefGoogle Scholar
  27. 27.
    de Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–22.CrossRefGoogle Scholar
  28. 28.
    Krajewski AC, Boughey JC, Degnim AC, et al: Expanded indications and improved outcomes for nipple-sparing mastectomy over time. Ann Surg Oncol. 2015;22:3317–23.CrossRefGoogle Scholar
  29. 29.
    Orcutt ST, O’Donoghue C, Smith P, et al: Expanding eligibility criteria for nipple-sparing mastectomy. South Med J. 2017;110:654–9.CrossRefGoogle Scholar
  30. 30.
    Agarwal S, Agarwal S, Neumayer L, et al. Therapeutic nipple-sparing mastectomy: trends based on a national cancer database. Am J Surg. 2014;208:93–8.CrossRefGoogle Scholar
  31. 31.
    Albright EL, Schroeder MC, Foster K, et al. Nipple-sparing mastectomy is not associated with a delay of adjuvant treatment. Ann Surg Oncol. 2018;25:1928–35.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Stephanie M. Wong
    • 1
    • 2
  • Yoon S. Chun
    • 3
  • Yasuaki Sagara
    • 2
  • Mehra Golshan
    • 1
    • 2
  • Jessica Erdmann-Sager
    • 3
    Email author
  1. 1.Division of Breast Surgery, Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Breast Oncology ProgramDana-Farber/Brigham and Women’s Cancer CenterBostonUSA
  3. 3.Division of Plastic Surgery, Department of SurgeryBrigham and Women’s HospitalBostonUSA

Personalised recommendations