Breast Cancer

, Volume 23, Issue 4, pp 552–560 | Cite as

Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy

  • Naomi Sakamoto
  • Eisuke Fukuma
  • Ko Teraoka
  • Kazuei Hoshi
Original Article



Endoscopic nipple-sparing mastectomy (E-NSM) has been reportedly associated with smaller scars and greater patient satisfaction; however, long-term results of this procedure have not been made. The purpose of this retrospective study was to investigate the local recurrence (LR) rate and factors associated with it after E-NSM and to examine the oncologic safety of this procedure.


We reviewed the medical records of a total of 421 breasts in 404 patients who underwent E-NSM to investigate the LR rate and the factors associated with it. The clinico-pathological features and the treatment and outcomes of the patients with LRs were also examined.


Eleven breasts (2.6 %) in 11 patients presented with LR as the first site of recurrence after a median follow-up time of 61 months. Among the 11 LRs, 9 patients presented with LR only, 1 patient exhibited regional lymph node recurrence, and 1 patient exhibited distant metastasis. The median time from surgery until LR was 25 months. Eight LRs developed near the original tumor site. The risk factors for LR in a multivariate analysis were a younger age of less than 40 years (p = 0.02), Stage III tumor (p = 0.01), and an inadequate surgical margin (p = 0.001). After the treatment, 6 patients had no evidence of disease, 2 patients died from metastatic disease, 2 patients experienced repeat LR, and the remaining patient who rejected excision exhibited a persistent LR.


E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy.


Local recurrence Endoscopic surgery Nipple-sparing mastectomy Breast cancer recurrence Nipple involvement 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Didier F, Radice D, Gandini S, Bedolis R, Rotmensz N, Maldifassi A, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118:623–33.CrossRefPubMedGoogle Scholar
  2. 2.
    Lambert PA, Kolm P, Perry RR. Parameters that predict nipple involvement in breast cancer. J Am Coll Surg. 2000;191:354–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Cense HA, Rutgers EJ, Lopes CM, Van Lanschot JJ. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol. 2001;27:521–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Simmons RM, Brennan M, Christos P, King V, Osborne M. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol. 2002;9:165–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Vlajcic Z, Zic R, Stanec S, Lambasa S, Petrovecki M, Stanec Z. Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg. 2005;55:240–4.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K. Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery. 2002;131:324–9.CrossRefGoogle Scholar
  8. 8.
    Ho WS, Ying SY, Chan AC. Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc. 2002;16:302–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Nakajima H, Sakaguchi K, Mizuta N, Hachimine T, Ohe S, Sawai K. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother. 2002;56:205–8.CrossRefGoogle Scholar
  10. 10.
    Ito K, Kanai T, Gomi K, Watanabe T, Ito T, Komatsu A, et al. Endoscopic-assisted skin-sparing mastectomy combined with sentinel node biopsy. ANZ J Surg. 2008;78:894–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Sakamoto N, Fukuma E, Higa K, Ozaki S, Sakamoto M, Abe S, et al. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol. 2009;16:3406–13.CrossRefPubMedGoogle Scholar
  12. 12.
    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;34:143–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Katz A, Strom EA, Buchholz TA, Theriault R, Singletary SE, McNeese MD. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys. 2001;50:735–42.CrossRefPubMedGoogle Scholar
  14. 14.
    Jaqsi R, Raad RA, Goldberg S, Sullivan T, Michaelson J, Powell SN, Taqhian AG. Locoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy: implications for postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2005;62:1035–9.CrossRefGoogle Scholar
  15. 15.
    Childs SK, Chen YH, Duggan MM, Golshan M, Pochebit S, Wong JS, Bellon JR. Surgical margins and the risk of local-regional recurrence after mastectomy without radiation therapy. Int J Radiat Oncol Biol Phys. 2012;84:1133–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Carlson GW, Styblo TM, Lyles RH, Jones G, Murray DR, Staley CA, Wood WC. The use of skin sparing mastectomy in the treatment of breast cancer: the Emory experience. Surg Oncol. 2003;12:265–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Vaughan A, Dietz JR, Aft R, Gillanders WE, Eberlein TJ, Freer P, Margenthaler JA. Scientific presentation award. Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg. 2007;194:438–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Petit JY, Veronesi U, Orecchia R, et al. Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia. Ann Oncol. 2012;23:2053–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Sheikh F, Rebecca A, Pockaj B, Wasif N, McCullough AE, Casey W, et al. Inadequate margins of excision when undergoing mastectomy for breast cancer: which patients are at risk? Ann Surg Oncol. 2011;18:952–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Truong PT, Olivotto IA, Speers CH, Wai ES, Berthelet E, Kader HA. A positive margin is not always an indication for radiotherapy after mastectomy in early breast cancer. Int J Radiat Oncol Biol Phys. 2004;58:797–804.CrossRefPubMedGoogle Scholar
  21. 21.
    Forman DL, Chiu J, Restifo RJ, Ward BA, Haffty B, Ariyan S. Breast reconstruction in previously irradiated patients using tissue expanders and implants:a potentially unfavorable result. Ann Plast Surg. 1998;40:360–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Cao D, Tsangaris TN, Kouprina N, Wu LS, Balch CM, Vang R, Argani P. The superficial margin of the skin-sparing mastectomy for breast carcinoma: factors predicting involvement and efficacy of additional margin sampling. Ann Surg Oncol. 2008;15:1330–40.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, Urist MM. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg. 2002;235:814–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Haffty BG, Hauser A, Choi DH, Parisot N, Rimm D, King B, Carter D. Molecular markers for prognosis after isolated postmastectomy chest wall recurrence. Cancer. 2004;100:252–63.CrossRefPubMedGoogle Scholar
  25. 25.
    Meretoja TJ, von Smitten KA, Leidenius MH, Svarvar C, Heikkilä PS, Jahkola TA. Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series. Eur J Surg Oncol. 2007;33:1142–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Carlson GW, Styblo TM, Lyles RH, Bostwick J, Murray DR, Staley CA, Wood WC. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol. 2003;10:108–12.CrossRefPubMedGoogle Scholar
  27. 27.
    Wijayanayagam A, Kumar AS, Foster RD, Esserman LJ. Optimizing the total skin-sparing mastectomy. Arch Surg. 2008;143:38–45.CrossRefPubMedGoogle Scholar
  28. 28.
    Sakamoto N, Tozaki M, Hoshi K, Fukuma E. Is MRI useful for the prediction of nipple involvement? Breast Cancer. 2013;20:316–22.CrossRefPubMedGoogle Scholar
  29. 29.
    Friedman EP, Hall-Craggs MA, Mumtaz H, Schneidau A. Breast MR and the appearance of the normal and abnormal nipple. Clin Radiol. 1997;52:854–61.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2015

Authors and Affiliations

  • Naomi Sakamoto
    • 1
  • Eisuke Fukuma
    • 1
  • Ko Teraoka
    • 1
  • Kazuei Hoshi
    • 2
  1. 1.Breast CenterKameda Medical CenterKamogawaJapan
  2. 2.Department of PathologyKameda Medical CenterKamogawaJapan

Personalised recommendations