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Surgical and oncological safety of nipple-sparing mastectomy in an Asian population

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Abstract

Background

Nipple-sparing mastectomy (NSM) allows for excellent postmastectomy reconstruction aesthetics and is used for both therapeutic and risk-reducing purposes. Reservations regarding the potential for locoregional recurrence and concerns about nipple–areolar complex (NAC) necrosis remain amongst many surgeons. We review the surgical and oncological outcomes after NSM in our institution.

Methods

All NSM cases at the National Cancer Centre Singapore and Singapore General Hospital between 2005 and 2015 were reviewed. Tumour characteristics, reconstruction methods, surgical and oncological outcomes are described.

Results

A total of 139 NSMs were performed for 130 patients. The median age was 46 years (range 21–66). The use of NSM increased from 2% of all breast reconstructions in 2005 to 37% in 2015. The majority (n = 119; 86%) were for cancer treatment and 20 (14%) for risk-reducing purposes. Among those performed for cancer, patients mainly had early stage breast cancer (n = 106, 89%). Autologous reconstruction (n = 111, 80%) was most common. Early complications requiring surgical intervention occurred in 24 (17%) NSMs, including 9 partial/complete flap loss and 2 complete NAC loss. Smoking, previous breast radiation and periareolar incision were all not associated with a higher re-intervention rate (p = 0.93, 0.41 and 0.91, respectively). Median follow-up was 43 months (range 5–145). Five patients (4%) developed local recurrence, including 2 NAC recurrences. The 2- and 5-year overall survival rate is 97 and 90%, respectively.

Conclusion

NSM is an oncologically safe procedure in selected patients with acceptable low complication rates.

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Authors and Affiliations

  1. Department of General Surgery, Singapore General Hospital, Singapore, Singapore

    Yvonne Ying-Ru Ng, Jasmine Hui-Er Chang, Chow Yin Wong & Benita Kiat Tee Tan

  2. Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Veronique Kiak-Mien Tan, Yirong Sim, Kong Wee Ong, Wei Sean Yong & Preetha Madhukumar

  3. Department of Plastics, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore

    Wan Sze Pek, Yee Siang Ong & Bien Keem Tan

Authors
  1. Yvonne Ying-Ru Ng
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  2. Veronique Kiak-Mien Tan
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  3. Wan Sze Pek
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  4. Jasmine Hui-Er Chang
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  6. Kong Wee Ong
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  12. Benita Kiat Tee Tan
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Correspondence to Veronique Kiak-Mien Tan.

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Ng, Y.YR., Tan, V.KM., Pek, W.S. et al. Surgical and oncological safety of nipple-sparing mastectomy in an Asian population. Breast Cancer 26, 165–171 (2019). https://doi.org/10.1007/s12282-018-0908-y

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  • DOI: https://doi.org/10.1007/s12282-018-0908-y

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