Breast Cancer Research and Treatment

, Volume 114, Issue 1, pp 97–101 | Cite as

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

  • J. Y. Petit
  • U. Veronesi
  • P. Rey
  • N. Rotmensz
  • E. Botteri
  • M. Rietjens
  • C. Garusi
  • F. De Lorenzi
  • S. Martella
  • R. Bosco
  • A. Manconi
  • A. Luini
  • V. Galimberti
  • P. Veronesi
  • G. B. Ivaldi
  • R. Orecchia
Clinical Trial

Abstract

Background When the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. Patients and methods From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1–60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. Results In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn’t find any significant difference in the local relapse rate according to different patient’s and tumour’s features. Most relapses were located close to the tumour bed but never in the NAC area. Conclusion Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT.

Keywords

Nipple-sparing Mastectomy Breast Conservative treatment 

References

  1. 1.
    Wellisch DK, Schain WS, Noone RB, Little JW 3rd (1987) The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg 80(5):699–704PubMedCrossRefGoogle Scholar
  2. 2.
    Petit JY, Veronesi U, Orecchia R, Luini A, Rey P, Didier F, Giraldo A, Luini A, De Lorenzi F, Rietjens M, Garusi C, Intra M, Yamaguchi S, Martella S (2003) The nipple sparing mastectomy: early results of a feasability study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori 89:288–291PubMedGoogle Scholar
  3. 3.
    Cense HA, Rutgers EJ, Lopes-Cardozo M, Van Lanschot JJ (2001) Nipple sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 6:521–526CrossRefGoogle Scholar
  4. 4.
    Lambert PA, Kolm P, Perry RR (2000) Parameters that predict nipple involvement in breast cancer. J Am Coll Surg 191(4):354–359PubMedCrossRefGoogle Scholar
  5. 5.
    Gajdos C, Tartter PI, Bleiweiss IJ (2000) Subareolar breast cancers. Am J Surg 180(3):167–170PubMedCrossRefGoogle Scholar
  6. 6.
    Vyas JJ, Chinoy RF, Vaidya JS (1998) Prediction of nipple and areola involvement in breast cancer. Eur J Surg Oncol 24(1):15–16PubMedCrossRefGoogle Scholar
  7. 7.
    Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE (1999) The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin sparing mastectomy. Ann Surg Oncol 6(6):609–613PubMedCrossRefGoogle Scholar
  8. 8.
    Gerber B, Krause A, Reimer T et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238(1):120–127PubMedCrossRefGoogle Scholar
  9. 9.
    Merrick HW, Battle JA, Padgett BJ, Dobelbower RR (1997) IORT for early breast cancer: a report on long-term results. Front Radiat Ther Oncol 31:126–130PubMedCrossRefGoogle Scholar
  10. 10.
    DuBois J-B, Hay M, Gely S, Saint-Aubert B, Rouanet P, Pujol H (1997) IORT in breast carcinomas. Front Radiat Ther Oncol 31:131–137PubMedCrossRefGoogle Scholar
  11. 11.
    Battle JA, DuBois J-B, Merrick HW, Dobelbower RR (1999) IORT for breast cancer. In: Gunderson LL et al (eds) Current clinical oncology: intraoperative irradiation: techniques and results. Humana Press Inc., New York, pp 521–526Google Scholar
  12. 12.
    Veronesi U, Orecchia R, Luini A, Gatti G, Intra M, Zurrida S, Ivaldi G, Tosi G, Ciocca M, Tosoni A, De Lucia F (2001) A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer 37:2178–2183PubMedCrossRefGoogle Scholar
  13. 13.
    Veronesi U, Orecchia R, Luini A, Galimberti V, Gatti G, Intra M, Veronesi P, Leonardi MC, Ciocca M, Lazzari R, Caldarella P, Simsek S, Santos Silva L, Sances D (2005) Full-dose intraoperative radiotherapy with electrons durign breast conserving surgery. Experience with 590 cases. Ann Surg 242:101–106PubMedCrossRefGoogle Scholar
  14. 14.
    Veronesi U, Orecchia R, Luini A, Gatti G, Intra M, Veronesi P et al (2001) Focalised intraoperative irradiation after conservative surgery for early stage breast cancer. Breast 10(Supplement-3):84–89Google Scholar
  15. 15.
    Gray RJ (1988) A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRefGoogle Scholar
  16. 16.
    Smith J, Payne WS, Carney JA (1976) Involvement of the nipple and areola in carcinoma of the breast. Surg Gynecol Obstet 143(4):546–548PubMedGoogle Scholar
  17. 17.
    Andersen JA, Pallesen RM (1979) Spread to the nipple and areola in carcinoma of the breast. Ann Surg 189(3):367–372PubMedCrossRefGoogle Scholar
  18. 18.
    Cucin RL, Guthrie RH Jr, Luterman A, Gray G, Goulian D Jr (1980) Screening the nipple for involvement in breast cancer. Ann Plast Surg 5(6):477–479PubMedCrossRefGoogle Scholar
  19. 19.
    Andersen JA, Gram JB, Pallesen RM (1981) Involvement of the nipple and areola in breast cancer. Value of clinical findings. Scand J Plast Reconstr Surg 15(1):39–42PubMedCrossRefGoogle Scholar
  20. 20.
    Schecter AK, Freeman MB, Giri D, Sabo E, Weinzweig J (2006) Applicability of the nipple-areola complex-sparing mastectomy: a prediction model using mammography to estimate risk of nipple-areola complex involvement in breast cancer patients. Ann Plast Surg 56(5):498–504, discussion 504PubMedCrossRefGoogle Scholar
  21. 21.
    Vlajcic Z, Zic R, Stanec S, Lambasa S, Petrovecki M, Stanec Z (2005) Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 55(3):240–244PubMedCrossRefGoogle Scholar
  22. 22.
    Lambert PA, Kolm P, Perry RR (2000) Parameters that predict nipple involvement in breast cancer. J Am Coll Surg 191(4):354–359PubMedCrossRefGoogle Scholar
  23. 23.
    Friedman EP, Hall-Craggs MA, Mumtaz H, Schneidau A (1997) Breast MR and the appearance of the normal and abnormal nipple. Clin Radiol 52(11):854–861PubMedCrossRefGoogle Scholar
  24. 24.
    Palmieri B, Baitchev G, Grappolini S, Costa A, Benuzzi G (2005) Delayed nipple-sparing modified subcutaneous mastectomy: rationale and technique. Breast J 11(3):173–178PubMedCrossRefGoogle Scholar
  25. 25.
    Govindarajulu S, Narreddy S, Shere MH, Ibrahim NB, Sahu AK, Cawthorn SJ (2006) Preoperative mammotome biopsy of ducts beneath the nipple areola complex. Eur J Surg Oncol 32(4):410–412PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • J. Y. Petit
    • 1
  • U. Veronesi
    • 2
  • P. Rey
    • 1
  • N. Rotmensz
    • 3
  • E. Botteri
    • 3
  • M. Rietjens
    • 1
  • C. Garusi
    • 1
  • F. De Lorenzi
    • 1
  • S. Martella
    • 1
  • R. Bosco
    • 1
  • A. Manconi
    • 1
  • A. Luini
    • 4
  • V. Galimberti
    • 4
  • P. Veronesi
    • 4
  • G. B. Ivaldi
    • 5
  • R. Orecchia
    • 5
  1. 1.Department of Plastic SurgeryEuropean Institute of OncologyMilanItaly
  2. 2.Scientific DirectionEuropean Institute of OncologyMilanItaly
  3. 3.Division of Epidemiology and BiostatisticsEuropean Institute of OncologyMilanItaly
  4. 4.Department of Breast SurgeryEuropean Institute of OncologyMilanItaly
  5. 5.Department of RadiotherapyEuropean Institute of OncologyMilanItaly

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