La radiologia medica

, Volume 122, Issue 3, pp 171–178 | Cite as

Radiotherapy and nipple–areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis

  • Yajuan Zheng
  • Miaochun Zhong
  • Chao Ni
  • Hongjun Yuan
  • Jingxia Zhang



To perform a meta-analysis to determine the effect of radiotherapy (RT) on nipple–areolar complex (NAC) and skin flap necrosis, and local recurrence in women who undergo nipple-sparing mastectomy (NSM) and immediate breast reconstruction.


Medline, PubMed, Cochrane, and Google Scholar databases were searched until October 16, 2015. Randomized-controlled-trials, prospective, retrospective, and cohort studies were included. The primary outcome was the NAC necrosis rate, and the secondary outcomes were the skin flap necrosis and local recurrence rates.


Of 186 studies identified, 2 prospective and 5 retrospective studies including a total of 3692 patients were included in the meta-analysis. Five, 3, and 2 studies reported data of NAC necrosis (3461 breasts), skin flap necrosis (2490 breasts), and local recurrence (988 breasts), respectively. Pooled results showed no difference in the odds of NAC necrosis [odds ratio (OR) = 1.250, 95% confidence interval (CI) 0.481–3.247, P = 0.647], or local recurrence (OR = 0.564, 95% CI 0.056–5.710, P = 0.627) between patients who received and did not receive RT. Patients treated with RT had a higher likelihood of skin flap necrosis (OR = 2.534, 95% CI 1.720–3.735, P < 0.001). Significant heterogeneity, however, was noted in the analysis of NAC and local recurrence.


Because of the limitations of the small number of studies and heterogeneity in the analysis, this study does not allow drawing any definitive conclusions and highlights the need of well-controlled trials to determine the effect of RT in patients undergoing NSM.


Breast cancer Necrosis Nipple–areolar complex Nipple-sparing mastectomy Recurrence 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Meta‐analyses do not involve human subjects and do not require IRB review (J Grad Med Educ. 2011 March; 3(1): 5–6.).

Supplementary material

11547_2016_702_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Yajuan Zheng
    • 1
  • Miaochun Zhong
    • 1
  • Chao Ni
    • 1
  • Hongjun Yuan
    • 1
  • Jingxia Zhang
    • 1
  1. 1.Department of Thyroid and Breast SurgeryZhejiang Provincial People’s HospitalHangzhouChina

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