Abstract
Background
As the demand for nipple-sparing mastectomy (NSM) increases and surgeons expand the eligibility criteria, a subset of patients may become candidates following neoadjuvant chemotherapy (NACT). However, the impact of NACT on postoperative complications remains unclear as the current literature is discordant.
Methods
A single-institution, retrospective chart review was performed on patients undergoing NSM from 1989 to 2017. Patient demographics, surgical intervention, systemic treatment, and complication rates were collected. Primary outcomes were 30-day postoperative complications, including nipple-areolar necrosis, skin flap necrosis, infection, wound dehiscence, hematoma, and seroma. Secondary outcomes included characterization of the timing between chemotherapy and surgical intervention, and the impact on complication rates. Each breast was considered independently for analysis, and breasts undergoing either NACT or primary surgery (PS) were compared.
Results
Of the 832 breasts included, 88 (10.6%) received NACT and 744 (89.4%) underwent PS. Baseline complication rates were not significantly different between the NACT group and the PS group (5.7% vs. 10.6%; p = 0.119). When controlling for age, body mass index (BMI), smoking, and prior radiation, NACT was not a predictor of complications. Time from completion of NACT to PS occurred at a median of 40.5 days (interquartile range 31.3–55.3), and decreased intervals were not associated with increased complication rates.
Conclusions
Postoperative complications following NSM in patients completing NACT are comparable with those receiving PS. Patients undergoing NACT do not have a significantly increased risk of necrosis, unintended reoperations, or nipple loss. NACT should not be considered a contraindication for NSM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Headon HL, Kasem A, Mokbel K. The oncological safety of nipple-sparing mastectomy: a systematic review of the literature with a pooled analysis of 12,358 procedures. Arch Plast Surg. 2016;43(4):328.
Wei CH, et al. Psychosocial and sexual well‐being following nipple‐sparing mastectomy and reconstruction. Breast J. 2016;22(1):10–17.
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(10):3218–3222.
Tousimis E, Haslinger M. Overview of indications for nipple sparing mastectomy. Gland Surg. 2018;7(3):288–300.
Agresti R, Sandri M, Gennaro M, Bianchi G, Maugeri I, Rampa M, et al. Evaluation of local oncologic safety in nipple–areola complex-sparing mastectomy after primary chemotherapy: a propensity score-matched study. Clin Breast Cancer 2017;17(3):219–231.
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(10):3294–3302.
Jadeja P, Ha R, Rohde C, Ascherman J, Grant R, Chin C, et al. Expanding the criteria for nipple-sparing mastectomy in patients with poor prognostic features. Clin Breast Cancer. 2018;18(3):229–233.
Sanford RA, Lei X, Barcenas CH, Mittendorf EA, Caudle AS, Valero V, et al. Impact of time from completion of neoadjuvant chemotherapy to surgery on survival outcomes in breast cancer patients. Ann Surg Oncol. 2016;23(5):1515–1521.
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):461–468.
Frey JD, Choi M, Karp NS. The effect of neoadjuvant chemotherapy compared to adjuvant chemotherapy in healing after nipple-sparing mastectomy. Plast Reconst Surg. 2017;139(1):10e–19e.
Santoro S, Loreti A, Cavaliere F, Costarelli L, La Pinta M, Manna E, et al. Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy. Breast. 2015;24(5):661–666.
JMP® version 13.1.0. Cary, NC: SAS Institute Inc.; 1989–2007.
Algaithy ZK, Petit JY, Lohsiriwat V, Maisonneuve P, Rey PC, Baros N, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surgic Oncol. 2012;38(2):125–129.
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):1410–1413.
Davies K, Allan L, Roblin P, Ross D, Farhadi J. Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction. Breast. 2011;20(1):21–25.
Gould DJ, Hunt KK, Liu J, Kuerer HM, Crosby MA, Babiera G, et al. Impact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nipple-sparing mastectomy. Plast Reconst Surg. 2013;132(3):330e.
Oh E, Chim H, Soltanian HT. The effects of neoadjuvant and adjuvant chemotherapy on the surgical outcomes of breast reconstruction. J Plast Reconst Aesthet Surg. 2012;65(10):e267–e280.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bartholomew, A.J., Dervishaj, O.A., Sosin, M. et al. Neoadjuvant Chemotherapy and Nipple-Sparing Mastectomy: Timing and Postoperative Complications. Ann Surg Oncol 26, 2768–2772 (2019). https://doi.org/10.1245/s10434-019-07418-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-019-07418-4