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Oncologic Safety of Nipple-Sparing Mastectomy in Patients with Breast Cancer and Tumor-to-Nipple Distance ≤ 1 cm: A Matched Cohort Study

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

Abstract

Background

A short tumor-to-nipple distance (TND) is reported as a strong predictor of nipple-areola complex (NAC) involvement. Eligibility for nipple-sparing mastectomy (NSM) remains controversial, especially regarding TND. In this study, we compared long-term oncologic outcomes after NSM between patients with a TND ≤ 1 cm and those with a TND > 1 cm.

Methods

Overall, 1369 patients with primary breast cancer who underwent NSM with immediate reconstruction from March 2003 to December 2015 were included for analysis. After propensity score matching, 495 patients with a TND ≤ 1 cm (group A) and 495 patients with a TND > 1 cm (group B) on imaging were selected to compare long-term oncologic outcomes.

Results

After matching, the median follow-up periods for surviving patients were 109 months and 112 months for groups A and B, respectively. There were no significant differences between groups with respect to the 5-year cumulative local recurrence (8.1% vs. 6.3%; p = 0.268), NAC recurrence (5.1% vs. 2.8%; p = 0.072), regional recurrence (2.0% vs. 3.6%; p = 0.125), or distant recurrence (5.9% vs. 4.8%; p = 0.480) rates. Furthermore, no significant differences were observed between the groups with respect to the 10-year local recurrence-free survival (87.1% vs. 90.7%; p = 0.164) or disease-free survival (77.9% vs. 81.6%; p = 0.222) rates.

Conclusions

A preoperative TND ≤ 1 cm on imaging should not be contraindicated to NSM as long as there is no involvement of NAC clinically or on imaging and if retroareolar margins are confirmed to be negative for tumor cells.

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Funding

No sources of funding were used to assist in the preparation of this study.

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Authors and Affiliations

  1. Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    Zhen-Yu Wu MD, PhD & Jing Han MD

  2. Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Zhen-Yu Wu MD, PhD, Hee Jeong Kim MD, PhD, Jongwon Lee MD, PhD, Il Yong Chung MD, Jisun Kim MD, PhD, Sae-Byul Lee MD, PhD, Byung-Ho Son MD, PhD, Sei-Hyun Ahn MD, PhD & BeomSeok Ko MD, PhD

  3. Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Hyun Ho Han MD, PhD & Jin-Sup Eom MD, PhD

  4. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Sung-Bae Kim MD, PhD & Kyung Hae Jung MD, PhD

  5. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Gyungyub Gong MD, PhD

  6. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Hak Hee Kim MD, PhD

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  1. Zhen-Yu Wu MD, PhD
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  2. Hee Jeong Kim MD, PhD
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  10. Jin-Sup Eom MD, PhD
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  11. Sung-Bae Kim MD, PhD
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  14. Hak Hee Kim MD, PhD
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  15. Sei-Hyun Ahn MD, PhD
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  16. BeomSeok Ko MD, PhD
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Corresponding author

Correspondence to BeomSeok Ko MD, PhD.

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Disclosure

Zhen-Yu Wu, Hee Jeong Kim, Jongwon Lee, Il Yong Chung, Jisun Kim, Sae-Byul Lee, Byung-Ho Son, Jing Han, Hyun Ho Han, Jin-Sup Eom, Sung-Bae Kim, Kyung Hae Jung, Gyungyub Gong, Hak Hee Kim, Sei-Hyun Ahn, and BeomSeok Ko declare no conflict of interest in relation to this article.

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Wu, ZY., Kim, H.J., Lee, J. et al. Oncologic Safety of Nipple-Sparing Mastectomy in Patients with Breast Cancer and Tumor-to-Nipple Distance ≤ 1 cm: A Matched Cohort Study. Ann Surg Oncol 28, 4284–4291 (2021). https://doi.org/10.1245/s10434-020-09427-0

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  • DOI: https://doi.org/10.1245/s10434-020-09427-0

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