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Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications

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

Abstract

Background

The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and reconstruction success rates in a contemporary patient cohort with expanded indications for NSM.

Methods

With institutional review board (IRB) approval, patients treated from 2009 to 2017 with NSM were identified from our prospective breast surgery registry. Main outcomes were 30-day complications requiring treatment and 1-year reconstruction failure rates. Risk factors were assessed using logistic regression.

Results

We evaluated 1301 breasts in 769 women undergoing NSM for cancer (n = 555) or risk reduction (n = 746) with median age of 48 (range 21–77) years. The overall 30-day complication rate was 7.5% (97/1301 breasts) and declined from 14.8% in 2009 to 6.3% in 2017 (p < 0.001), while the proportion of patients with obesity (p = 0.007) and treated with neoadjuvant chemotherapy (p < 0.001) increased. Prior radiation [odds ratio (OR) 2.35, p = 0.04], recent/current smoking (OR 3.37, p < 0.001), and body mass index (BMI) (OR 1.28 per 5-kg/m2 increase, p = 0.03) significantly increased 30-day complication rates. Reconstruction success at 1 year was 96.7%. Prior radiation (OR 5.65, p < 0.001), axillary surgery (OR 2.55, p = 0.006), and postoperative adjuvant radiation (OR 3.22, p = 0.007) significantly affected 1-year reconstruction failure.

Conclusion

The 30-day complication rates of NSM decreased, despite broadened indications among higher-risk patients over time. These data confirm a team learning curve with NSM and also demonstrate that the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment.

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Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Whitney A. Young MD, Amy C. Degnim MD, James W. Jakub MD, Minh-Doan Nguyen MD, Nho V. Tran MD, Christin A. Harless MD, Oscar J. Manrique MD, Judy C. Boughey MD & Tina J. Hieken MD

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS

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  1. Whitney A. Young MD
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  2. Amy C. Degnim MD
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Correspondence to Tina J. Hieken MD.

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Dr. Hieken has unrelated research support from Genentech; the other authors report no relevant financial disclosures.

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Young, W.A., Degnim, A.C., Hoskin, T.L. et al. Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications. Ann Surg Oncol 26, 3115–3123 (2019). https://doi.org/10.1245/s10434-019-07560-z

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