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Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia

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

Abstract

Background

Nipple-sparing mastectomy (NSM) is an oncologically safe approach for breast cancer treatment and prevention; however, there are little long-term data to guide management for patients whose nipple margins contain tumor or atypia.

Methods

NSM patients with tumor or atypia in their nipple margin were identified from a prospectively maintained, single-institution database of consecutive NSMs. Patient and tumor characteristics, treatment, recurrence, and survival data were assessed.

Results

A total of 3158 NSMs were performed from June 2007 to August 2019. Nipple margins contained tumor in 117 (3.7%) NSMs and atypia only in 164 (5.2%) NSMs. Among 117 nipple margins that contained tumor, 34 (29%) margins contained invasive cancer, 80 (68%) contained ductal carcinoma in situ only, and 3 (3%) contained lymphatic vessel invasion only. Management included nipple-only excision in 67 (57%) breasts, nipple-areola complex excision in 35 (30%) breasts, and no excision in 15 (13%) breasts. Only 23 (24%) excised nipples contained residual tumor. At 67 months median follow-up, there were 2 (1.8%) recurrences in areolar or peri-areolar skin, both in patients with nipple-only excision. Among 164 nipple margins containing only atypia, 154 (94%) nipples were retained. At 60 months median follow-up, no patient with atypia alone had a nipple or areola recurrence.

Conclusions

Nipple excision is effective management for nipple margins containing tumor. No intervention is required for nipple margins containing only atypia. Our results support broad eligibility for NSM with careful nipple margin assessment.

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Authors and Affiliations

  1. Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA

    Julia N. Shanno BS, Abigail E. Daly BA, Kyle J. Anderman BS, Heidi S. Santa Cruz BA, Alexandra J. Webster BS, Robert M. Pride MD, Michelle C. Specht MD, Michele A. Gadd MD, Tawakalitu O. Oseni MD, Francys C. Verdial MD, MPH, Tolga Ozmen MD, Rebecca Kwait MD & Barbara L. Smith MD, PhD

  2. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA

    Amy S. Colwell MD

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Correspondence to Barbara L. Smith MD, PhD.

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Julia N. Shanno, Abigail E. Daly, Kyle J. Anderman, Heidi S. Santa Cruz, Alexandra J. Webster, Robert M. Pride, Michelle C. Specht, Michele A. Gadd, Tawakalitu O. Oseni, Francys C. Verdial, Tolga Ozmen, Rebecca Kwait, Amy S. Colwell, and Barbara L. Smith have no disclosures to declare in relation to this work.

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Shanno, J.N., Daly, A.E., Anderman, K.J. et al. Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15362-1

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