Skip to main content

Advertisement

SpringerLink
Log in

Oncological Outcomes of Nipple-Sparing Mastectomy: A Single-Center Experience of 1989 Patients

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

Abstract

Background

Nipple-sparing mastectomy (NSM) is increasingly used in women with breast cancer who are not eligible for conservative surgery, but extensive outcome data are lacking and indications have not been established.

Objective

The aim of this study was to assess the oncological outcomes of NSM in a large series of patients with invasive or in situ breast cancer treated at a single center.

Methods

We analyzed 1989 consecutive women who had an NSM in 2003–2011, for invasive (1711 patients) or in situ cancer (278 patients) at the European Institute of Oncology, Italy, and followed-up to December 2016. Endpoints were local recurrences, recurrences in the nipple-areola complex (NAC), NAC necrosis, and overall survival (OS).

Results

After a median follow-up of 94 months (interquartile range 70–117), 91/1711 (5.3%) patients with invasive cancer had local recurrence (4.8% invasive disease, 0.5% in situ disease), and 11/278 (4.0%) patients with in situ disease had local recurrence (1.8% invasive disease, 2.2% in situ disease). Thirty-six (1.8%) patients had NAC recurrence, 9 with in situ disease (4 invasive and 5 in situ recurrences), and 27 with invasive disease (18 invasive and 9 in situ recurrences). NAC loss for necrosis occurred in 66 (3.3%) patients. There were 131 (6.6%) deaths, 109 (5.5%) as a result of breast cancer. OS at 5 years was 96.1% in women with invasive cancer and 99.2% in women with in situ disease.

Conclusions

The findings in this large series, with a median follow-up of nearly 8 years, indicate that NSM is oncologically safe for selected patients. The rate of NAC loss was acceptably low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Veronesi U, Stafyla V, Luini A, et al. Breast cancer: from “maximum tolerable” to “minimum effective” treatment. Front Oncol. 2012;2:125.

    PubMed  PubMed Central  Google Scholar 

  2. Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16:387–95.

    Article  CAS  Google Scholar 

  3. Jabor MA, Shayani P, Collins DR Jr, et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg. 2002;110:457–63.

    Article  Google Scholar 

  4. Wei CH, Scott AM, Price AN, et al. Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction. Breast J. 2016;22:10–7.

    Article  Google Scholar 

  5. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118(3):623–33.

    Article  CAS  Google Scholar 

  6. Zhong T, Antony A, Cordeiro P. Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions. Ann Plast Surg. 2009;62:591–95.

    Article  CAS  Google Scholar 

  7. Simmons RM, Adamovich TL. Skin-sparing mastectomy. Surg Clin North Am. 2003;83:885–99.

    Article  Google Scholar 

  8. Van Verschuer VM, Mureau MA, Gopie JP, et al. Patient satisfaction and nipple-areola sensitivity after bilateral prophylactic mastectomy and immediate implant breast reconstruction in a high breast cancer risk population: NSM versus SSM. Ann Plast Surg. 2016;77:145–52.

    Article  Google Scholar 

  9. Djohan R, Gage E, Gatherwright J, et al. Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study. Plast Reconstr Surg. 2010;125:818–29.

    Article  CAS  Google Scholar 

  10. Sisco M, Yao KA. Nipple-sparing mastectomy: a contemporary perspective. J Surg Oncol. 2016;113:883–90.

    Article  Google Scholar 

  11. Gahm J, Hansson P, Brandberg Y, et al. Breast sensibility after bilateral risk-reducing mastectomy and immediate breast reconstruction: a prospective study. J Plast Reconstr Aesthet Surg. 2013;66:1521–27.

    Article  Google Scholar 

  12. Sarhadi NS, Shaw Dunn J, Lee FD, et al. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49:156–64.

    Article  CAS  Google Scholar 

  13. Schlenz I, Kuzbari R, Gruber H, et al. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000;105:905–9.

    Article  CAS  Google Scholar 

  14. NCCN clinical practice guidelines in oncology: breast cancer, version 2.2016. https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed 12 Sep 2018.

  15. Fortunato L, Loreti A, Andrich R, et al. When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol. 2013;108:207–12.

    Article  Google Scholar 

  16. Özkurt E, Tükenmez M, Güven E, et al. Favorable outcome with close margins in patients undergoing nipple/skin sparing mastectomy with immediate breast reconstruction: 5-year follow-up. Balkan Med J. 2018;35:84–92.

    Article  Google Scholar 

  17. Orecchia R, Veronesi U. Intraoperative electrons. Semin Radiat Oncol. 2005;15:76–83.

    Article  Google Scholar 

  18. Veronesi U, Gatti G, Luini A, et al. Intraoperative radiation therapy for breast cancer: technical notes. Breast J. 2003;9:106–12.

    Article  Google Scholar 

  19. Gorai K, Inoue K, Saegusa N, et al. Prediction of skin necrosis after mastectomy for breast cancer using indocyanine green angiography imaging. Plast Reconstr Surg Glob Open. 2017;5(4):e1321.

    Article  Google Scholar 

  20. De Lorenzi F, Yamaguchi S, Petit JY, et al. Evaluation of skin perfusion after nipple-sparing mastectomy by indocyanine green dye. Preliminary results. J Exp Clin Cancer Res. 2005;24(3):347–54.

    PubMed  Google Scholar 

  21. Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. New York: Wiley; 1980.

    Google Scholar 

  22. Gray RJ. A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;6:1141–54.

    Article  Google Scholar 

  23. Altman DG, De Stavola BL, Love SB, et al. Review of survival analyses published in cancer journals. Br J Cancer. 1995;72:511–18.

    Article  CAS  Google Scholar 

  24. Shimo A, Tsugawa K, Tsuchiya S, et al. Oncologic outcomes and technical considerations of nipple-sparing mastectomies in breast cancer: experience of 425 cases from a single institution. Breast Cancer. 2016;23:851–860.

    Article  Google Scholar 

  25. Boneti C, Yuen J, Santiago C, et al. Oncologic safety of nipple skin-sparing or total skin-sparing mastectomies with immediate reconstruction. J Am Coll Surg. 2011;212:686–93.

    Article  Google Scholar 

  26. Sakurai T, Zhang N, Suzuma T, et al. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol. 2013;30:481.

    Article  Google Scholar 

  27. Laurberg T, Tramm T, Nielsen T, et al. Intrinsic subtypes and benefit from postmastectomy radiotherapy in node-positive premenopausal breast cancer patients who received adjuvant chemotherapy: results from two independent randomized trials. Acta Oncol. 2018;57:38–43.

    Article  Google Scholar 

  28. Lai SF, Chen YH, Kuo WH, et al. Locoregional recurrence risk for postmastectomy breast cancer patients with T1-2 and one to three positive lymph nodes receiving modern systemic treatment without radiotherapy. Ann Surg Oncol. 2016;23:3860–69.

    Article  Google Scholar 

  29. Scheer AS, Zih FS, Maki E, et al. Post-mastectomy radiation: should subtype factor into the decision? Ann Surg Oncol. 2016;23:2462–70.

    Article  Google Scholar 

  30. Dominici LS, Mittendorf EA, Wang X, et al. Implications of constructed biologic subtype and its relationship to locoregional recurrence following mastectomy. Breast Cancer Res. 2012;14:R82.

    Article  Google Scholar 

  31. 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;43:328–38.

    Article  Google Scholar 

  32. Lohsiriwat V, Rotmensz N, Botteri E, et al. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol. 2013;20:990–6.

    Article  Google Scholar 

  33. Garwood ER, Moore D, Ewing C, et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249:26–32.

    Article  Google Scholar 

  34. Setälä L, Papp A, Joukainen S, et al. Obesity and complications in breast reduction surgery: are restrictions justified? J Plast Reconstr Aesthet Surg. 2009;62:195–99.

    Article  Google Scholar 

  35. O’Grady KF, Thoma A, Dal Cin A. A comparison of complication rates in large and small inferior pedicle reduction mammaplasty. Plast Reconstr Surg. 2005;115:736–42.

    Article  Google Scholar 

  36. De La Cruz L, Moody AM, Tappy EE, et al. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol. 2015;22:3241–49.

    Article  Google Scholar 

  37. Medina-Franco H, Vasconez LO, Fix RJ, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg. 2002;235:814–19.

    Article  Google Scholar 

  38. Crowe JP Jr, Gordon NH, Antunez AR, et al. Local-regional breast cancer recurrence following mastectomy. Arch Surg. 1991;126:429–32.

    Article  Google Scholar 

  39. Tokin C, Weiss A, Wang-Rodriguez J, et al. Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol. 2012;2012:921821.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgment

The authors thank Maria Grazia Villardita for help with manuscript preparation, and Don Ward for help with the English.

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. Division of Senology, IRCCS European Institute of Oncology, Milan, Italy

    Viviana Galimberti MD, Consuelo Morigi MD, Giovanni Corso MD, Elisa Vicini MD, Sabrina Kahler Ribeiro Fontana MD, Paola Naninato MD, Silvia Ratini MD, Francesca Magnoni MD, Antonio Toesca MD, Andriana Kouloura MD & Paolo Veronesi MD

  2. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy

    Vincenzo Bagnardi PhD

  3. University of Milan School of Medicine, Milan, Italy

    Paolo Veronesi MD

  4. Division of Plastic and Reconstructive Surgery, IRCCS European Institute of Oncology, Milan, Italy

    Mario Rietjens MD & Francesca De Lorenzi MD

  5. Department of Pathology, IRCCS European Institute of Oncology, Milan, Italy

    Andrea Vingiani MD

  6. Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Sabrina Kahler Ribeiro Fontana MD

Authors
  1. Viviana Galimberti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Consuelo Morigi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Bagnardi PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Corso MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisa Vicini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sabrina Kahler Ribeiro Fontana MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paola Naninato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Silvia Ratini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesca Magnoni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Antonio Toesca MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andriana Kouloura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mario Rietjens MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Francesca De Lorenzi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Andrea Vingiani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Paolo Veronesi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Viviana Galimberti MD.

Ethics declarations

Conflicts of interest

Viviana Galimberti, Consuelo Morigi, Vincenzo Bagnardi, Giovanni Corso, Elisa Vicini, Sabrina Kahler Ribeiro Fontana, Paola Naninato, Silvia Ratini, Francesca Magnoni, Antonio Toesca, Andriana Kouloura, Mario Rietjens, Francesca De Lorenzi, Andrea Vingiani, and Paolo Veronesi have no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galimberti, V., Morigi, C., Bagnardi, V. et al. Oncological Outcomes of Nipple-Sparing Mastectomy: A Single-Center Experience of 1989 Patients. Ann Surg Oncol 25, 3849–3857 (2018). https://doi.org/10.1245/s10434-018-6759-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6759-0

Keywords

Search

Navigation