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Oncological Outcomes of Total Skin-Sparing Mastectomy for Invasive Lobular Carcinoma of the Breast: A 20-Year Institutional Experience

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

Abstract

Background

Although rates of total skin-sparing (nipple-sparing) mastectomies are increasing, the oncologic safety of this procedure has not been evaluated in invasive lobular carcinoma (ILC). ILC is the second most common type of breast cancer, and its diffuse growth pattern and high positive margin rates potentially increase the risk of poor outcomes from less extensive surgical resection.

Methods

We compared time to local recurrence and positive margin rates in a cohort of 300 patients with ILC undergoing either total skin-sparing mastectomy (TSSM), skin-sparing mastectomy, or simple mastectomy between the years 2000–2020. Data were obtained from a prospectively maintained institutional database and were analyzed by using univariate statistics, the log-rank test, and multivariate Cox proportional hazards models.

Results

Of 300 cases, mastectomy type was TSSM in 119 (39.7%), skin-sparing mastectomy in 52 (17.3%), and simple mastectomy in 129 (43%). The rate of TSSM increased significantly with time (p < 0.001) and was associated with younger age at diagnosis (p = 0.0007). There was no difference in time to local recurrence on univariate and multivariate analysis, nor difference in positive margin rates by mastectomy type. Factors significantly associated with shorter local recurrence-free survival were higher tumor stage and tumor grade.

Conclusions

TSSM can be safely offered to patients with ILC, despite the diffuse growth pattern seen in this tumor type.

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References

  1. Wong SM, Chun YS, Sagara Y, Golshan M, Erdmann-Sager J. National patterns of breast reconstruction and nipple-sparing mastectomy for breast cancer, 2005–2015. Ann Surg Oncol. 2019;26:3194–203.

    Article  Google Scholar 

  2. Romanoff A, Zabor EC, Stempel M, Sacchini V, Pusic A, Morrow M. A comparison of patient-reported outcomes after nipple-sparing mastectomy and conventional mastectomy with reconstruction. Ann Surg Oncol. 2018;25:2909–16.

    Article  Google Scholar 

  3. Bailey CR, Ogbuagu O, Baltodano PA, et al. Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction. Plast Reconstr Surg. 2017;140:219–26.

    Article  CAS  Google Scholar 

  4. Agha RA, Al Omran Y, Wellstead G, et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open. 2019;3:135–45.

    Article  CAS  Google Scholar 

  5. Mota BS, Riera R, Ricci MD, et al. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev. 2016;11:CD008932.

  6. Galimberti V, Morigi C, Bagnardi V, et al. Oncological outcomes of nipple-sparing mastectomy: a single-center experience of 1989 patients. Ann Surg Oncol. 2018;25:3849–57.

    Article  Google Scholar 

  7. Sood S, Elder E, French J. Nipple-sparing mastectomy with implant reconstruction: the Westmead experience. ANZ J Surg. 2015;85:363–7.

    Article  Google Scholar 

  8. Murphy BL, Hoskin TL, Boughey JC, et al. Outcomes and feasibility of nipple-sparing mastectomy for node-positive breast cancer Patients. Am J Surg. 2017;213:810–3.

    Article  Google Scholar 

  9. Adam H, Bygdeson M, de Boniface J. The oncological safety of nipple-sparing mastectomy—a Swedish matched cohort study. Eur J Surg Oncol. 2014;40:1209–15.

    Article  CAS  Google Scholar 

  10. Brachtel EF, Rusby JE, Michaelson JS, et al. Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol. 2009;27:4948–54.

    Article  Google Scholar 

  11. D’Alonzo M, Martincich L, Biglia N, et al. Clinical and radiological predictors of nipple-areola complex involvement in breast cancer patients. Eur J Cancer. 2012;48:2311–8.

    Article  Google Scholar 

  12. Margenthaler JA, Gan C, Yan Y, et al. Oncologic safety and outcomes in patients undergoing nipple-sparing mastectomy. J Am Coll Surg. 2020;230:535–41.

    Article  Google Scholar 

  13. Smith BL, Tang R, Rai U, et al. Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg. 2017;225:361–5.

    Article  Google Scholar 

  14. Wu ZY, Kim HJ, Lee JW, et al. Breast cancer recurrence in the nipple-areola complex after nipple-sparing mastectomy with immediate breast reconstruction for invasive breast cancer. JAMA Surg. 2019.

  15. Wang J, Xiao X, Wang J, et al. Predictors of nipple-areolar complex involvement by breast carcinoma: histopathologic analysis of 787 consecutive therapeutic mastectomy specimens. Ann Surg Oncol. 2012;19:1174–80.

    Article  Google Scholar 

  16. Sledge GW, Chagpar A, Perou C. Collective wisdom: lobular carcinoma of the breast. Am Soc Clin Oncol Educ Book 2016;35:18–21.

    Article  Google Scholar 

  17. Fortunato L, Mascaro A, Poccia I, et al. Lobular breast cancer: same survival and local control compared with ductal cancer, but should both be treated the same way? Analysis of an institutional database over a 10-year period. Ann Surg Oncol. 2012;19:1107–14.

    Article  Google Scholar 

  18. Winchester DJ, Chang HR, Graves TA, Menck HR, Bland KI, Winchester DP. A comparative analysis of lobular and ductal carcinoma of the breast: presentation, treatment, and outcomes. J Am Coll Surg. 1998;186:416–22.

    Article  CAS  Google Scholar 

  19. Johnson K, Sarma D, Hwang ES. Lobular breast cancer series: imaging. Breast Cancer Res. 2015;17:94.

    Article  Google Scholar 

  20. Mallon P, Feron JG, Couturaud B, et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg. 2013;131:969–84.

    Article  CAS  Google Scholar 

  21. Tang R, Coopey SB, Merrill AL, et al. Positive nipple margins in nipple-sparing mastectomies: rates, management, and oncologic safety. J Am Coll Surg. 2016;222:1149–55.

    Article  Google Scholar 

  22. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21:717–30.

    Article  Google Scholar 

  23. Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plast Reconstr Surg. 2010;126:1460–71.

    Article  CAS  Google Scholar 

  24. 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 

  25. Amara D, Peled AW, Wang F, Ewing CA, Alvarado M, Esserman LJ. Tumor involvement of the nipple in total skin-sparing mastectomy: strategies for management. Ann Surg Oncol. 2015;22:3803–8.

    Article  Google Scholar 

  26. Haslinger ML, Sosin M, Bartholomew AJ, et al. Positive nipple margin after nipple-sparing mastectomy: an alternative and oncologically safe approach to preserving the nipple-areolar complex. Ann Surg Oncol. 2018;25:2303–7.

    Article  Google Scholar 

  27. Yu J, Al Mushawah F, Taylor ME, et al. Compromised margins following mastectomy for stage I-III invasive breast cancer. J Surg Res. 2012;177:102–8.

    Article  Google Scholar 

  28. Childs SK, Chen YH, Duggan MM, et al. Surgical margins and the risk of local-regional recurrence after mastectomy without radiation therapy. Int J Radiat Oncol Biol Phys. 2012;84:1133–8.

    Article  Google Scholar 

  29. Nguyen PL, Taghian AG, Katz, MS, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008; 26:2373–8.

    Article  Google Scholar 

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Acknowledgements

The authors thank Pamela Derish, MA, from the Department of Surgery at UCSF for editorial assistance and manuscript preparation.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of California, San Francisco, CA, USA

    Jennifer D. Son MD, Kelly Hewitt MD, Michael Alvarado MD, Laura J. Esserman MD, Cheryl Ewing MD, Jasmine M. Wong MD & Rita A. Mukhtar MD

  2. Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, CA, USA

    Merisa Piper MD

Authors
  1. Jennifer D. Son MD
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  2. Merisa Piper MD
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  3. Kelly Hewitt MD
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  4. Michael Alvarado MD
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  5. Laura J. Esserman MD
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  6. Cheryl Ewing MD
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  7. Jasmine M. Wong MD
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  8. Rita A. Mukhtar MD
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Corresponding author

Correspondence to Rita A. Mukhtar MD.

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Disclosures

Laura Esserman—Dr. Esserman is an unpaid member of the board of directors of Quantum Leap Healthcare Collaborative, and received grant funding from QLHC for the I-SPY TRIAL; she is a member of the Blue Cross/Blue Shield Medical Advisory Panel; she has a grant from Merck for an Investigator-initiated trial of DCIS.

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Son, J.D., Piper, M., Hewitt, K. et al. Oncological Outcomes of Total Skin-Sparing Mastectomy for Invasive Lobular Carcinoma of the Breast: A 20-Year Institutional Experience. Ann Surg Oncol 28, 2555–2560 (2021). https://doi.org/10.1245/s10434-020-09042-z

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  • DOI: https://doi.org/10.1245/s10434-020-09042-z

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