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Oncological and Surgical Outcomes After Nipple-Sparing Mastectomy: Do Incisions Matter?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

While nipple-sparing mastectomy (NSM) for the treatment of breast cancer is becoming more accepted, technical aspects are still evolving. Data regarding risk factors contributing to complications after NSM are limited. This study evaluated technical aspects on outcomes of NSM.

Methods

Review of our database identified 201 patients who had NSM during the period from January 2012 to June 2015. We compared the effect of operative techniques on surgical outcomes.

Results

A total of 351 NSM were performed in 201 patients. Mean patient age was 47 years. Inframammary (47 %) or periareolar (35 %) incisions were most frequent. Tumescence was used in 203 (58 %) NSM. Skin flaps were created using sharp dissection in 213 (61 %) and electrocautery in 138 (39 %) breasts. Nipple areola complex (NAC) necrosis was seen in 56 (16 %) breasts, of which 7 were severe (2 %). A higher rate of NAC complications was seen with periareolar incisions (p = 0.02). Sharp dissection did not result in significant rates of flap necrosis compared with electrocautery. Ten patients (3 %) had a positive anterior/deep margin, of which 7 (64 %) had an inframammary approach. Twenty-two (11 %) patients had an infection that required intravenous antibiotics. Fourteen (7 %) patients had implant loss. Dissection technique was not associated with implant loss (p = 1.0) or infection (p = 0.84). Forty-two (12 %) patients had radiation and seven (16 %) required implant removal.

Conclusions

NSM has an acceptable complication rate. NAC necrosis requiring excision or implant loss is rare. Postmastectomy radiation is a significant risk factor for implant loss. Inframammary incisions have fewer ischemic complications but may result in tumor-involved margins.

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References

  1. Agarwal S, Agarwal S, Neumayer L, Agarwal JP. Therapeutic nipple-sparing mastectomy: trends based on a national cancer database. Am J Surg. 2014;208(1):93–8.

    Article  PubMed  Google Scholar 

  2. de Alcantara Filho P, 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(11):3117–22.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg. 2009;249(3):461–8.

    Article  PubMed  Google Scholar 

  5. Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008;34(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  6. Orzalesi L, Casella D, Santi C, et al. Nipple sparing mastectomy: surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period. Breast. 2016;25:75–81.

    Article  PubMed  Google Scholar 

  7. Frey JD, Alperovich M, Kim JC, et al. Oncologic outcomes after nipple-sparing mastectomy: a single-institution experience. J Surg Oncol. 2016;113:8–11.

    Article  PubMed  Google Scholar 

  8. Endara M, Chen D, Verma K, Nahabedian MY, Spear SL. Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis. Plast Reconstr Surg. 2013;132:1043–54.

    Article  CAS  PubMed  Google Scholar 

  9. Gould DJ, Hunt KK, Liu J, Kuerer HM, Crosby MA, Babiera G, Kronowitz SJ. Impact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nipple-sparing mastectomy. Plast Reconstr Surg. 2013;132(3):330e–8e.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dent BL, Small K, Swistel A, Talmor M. Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment. Aesthet Surg J. 2014;34(4):560-70.

    Article  PubMed  Google Scholar 

  11. Tang R, Coopey SB, Colwell AS, et al. Nipple-sparing mastectomy in irradiated breasts: Selecting patients to minimize complications. Ann Surg Oncol. 2015;22:3331–7.

    Article  PubMed  Google Scholar 

  12. Archambeau JO, Pezner R, Wasserman T. Pathophysiology of irradiated skin and breast. Int J Radiat Oncol Biol Phys. 1995;31:1171–85.

    Article  CAS  PubMed  Google Scholar 

  13. Matsen CB, Mehrara B, Eaton A, et al. Skin flap necrosis after mastectomy with reconstruction: a prospective study. Ann Surg Oncol. 2016;23:257–64.

    Article  PubMed  Google Scholar 

  14. Regolo L, Ballardini B, Gallarotti E, Scoccia E, Zanini V. Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast. 2008;17(1):8–11.

    Article  CAS  PubMed  Google Scholar 

  15. Peled AW, Foster RD, Ligh C, Esserman JL, Fowble B, Sbitany H, et al. Impact of total skin-sparing mastectomy incision type on reconstructive complications following radiation therapy. Plast Reconstr Surg. 2014;134(4):169–75.

    Article  CAS  PubMed  Google Scholar 

  16. Wijayanayagam A, Kumar AS, Foster RD, et al. Optimizing the total skin-sparing mastectomy. Arch Surg. 2008;143:38–45.

    Article  PubMed  Google Scholar 

  17. Moyer HR, Ghazi B, Daniel JR, Gasgarth R, Carlson GW. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg. 2012;68:446–50.

    Article  CAS  PubMed  Google Scholar 

  18. Sisco M, Yao KA. Nipple-sparing mastectomy: a contemporary perspective. J Surg Oncol. 2016. doi:10.1002/jso.24209.

    Google Scholar 

  19. Komorowski AL, Zanini V, Regolo L, Carolei A, Wysocki WM, Costa A. Necrotic complications after nipple-and areola-sparing mastectomy. World J Surg. 2006;30(8):1410–3.

    Article  PubMed  Google Scholar 

  20. Garwood ER, Moore D, Ewing C, Hwang ES, Alvarado M, Foster RD, Esserman JL. Total skin-sparing mastectomy: Complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249:26–32.

    Article  PubMed  Google Scholar 

  21. Rawlani V, Fluk J, Johanson SA, et al. The effect of incision choice on outcome of nipple-sparing mastectomy reconstruction. Can J Past Surg. 2011;19(4):129–33.

    Google Scholar 

  22. Blechman RM, Karp NS, Levovitz C, et al. The lateral inframammary fold incision for nipple-sparing mastectomy: Outcomes from over 50 immediate implant-based breast constructions. Breast J. 2013;19:31–40.

    Article  PubMed  Google Scholar 

  23. Seitz IA, Nixon AT, Friedewald SM, Rimler JC, Schechter LS. “NACsomes”: a new classification system of the blood supply to the nipple areola complex (NAC) based on diagnostic breast MRI exams. J Plast Reconstr Aesthet Surg. 2015;68:792–9.

    Article  PubMed  Google Scholar 

  24. Eriksson M, Anveden L, Celebioglu F. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat. 2013;142:591–601.

    Article  PubMed  Google Scholar 

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Acknowledgment

The study was supported by grants from The Fashion Footwear Charitable Foundation of New York, Inc., Associates for Breast and Prostate Cancer Studies, The Avon Foundation, and The Margie and Robert E. Petersen Foundation.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Cory A. Donovan MD, Attiya P. Harit MS, Alice Chung MD, Jean Bao MD, Armando E. Giuliano MD & Farin Amersi MD

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  1. Cory A. Donovan MD
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  2. Attiya P. Harit MS
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  3. Alice Chung MD
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  4. Jean Bao MD
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  5. Armando E. Giuliano MD
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  6. Farin Amersi MD
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Correspondence to Farin Amersi MD.

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Donovan, C.A., Harit, A.P., Chung, A. et al. Oncological and Surgical Outcomes After Nipple-Sparing Mastectomy: Do Incisions Matter?. Ann Surg Oncol 23, 3226–3231 (2016). https://doi.org/10.1245/s10434-016-5323-z

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  • DOI: https://doi.org/10.1245/s10434-016-5323-z

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