Skip to main content


Log in

Nipple-Sparing Mastectomies in Patients over the Age of 60 Years: Factors Associated with Surgical Outcomes

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



Nipple-sparing mastectomy (NSM) outcomes in the elderly have not been well characterized. The goal of this study was to evaluate NSM outcomes in patients over age 60.

Patients and Methods

A single-institution retrospective cohort study was performed for NSM patients over the age of 60 from January 2004 to January 2022. Demographic, intraoperative, and postoperative variables were collected.


We identified 136 women who underwent a total of 200 NSMs at a mean age 65.2 years and with mean body mass index of 25. Most (56%) had invasive breast cancer, requiring neoadjuvant chemotherapy in 15%, and 17.5% had radiation prior to NSM. A total of 91% had immediate tissue expander placement. The infection rate was 19%, with 11.5% requiring expander explantation in the follow-up period. In binomial logistic regression analysis, prior radiation increased the odds of any complication by 2.9 (OR 2.93, CI 1.30–6.58, p = 0.009) and increased the odds of infection by 5.7 (OR 5.70, CI 1.95–16.66, p = 0.001), but no associations were seen for other covariates including age, comorbidities, prior chemotherapy, or presence of invasive disease. Diabetes increased the odds of wound breakdown specifically by 9.0 (OR 8.97, CI 2.01–39.92, p = 0.004). Local recurrence was 3% in mean 3.4-year follow-up.


Our data support NSM in patients over the age of 60 years with acceptable outcomes within the standard of care. Locoregional recurrence was within the cited range of 0–5%, and only diabetes and prior radiation were associated with reconstructive complications. NSM should thus be offered when appropriate regardless of increased age to achieve oncologic and reconstructive goals.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others


  1. Mesdag V, Régis C, Tresch E, et al. Nipple sparing mastectomy for breast cancer is associated with high patient satisfaction and safe oncological outcomes. J Gynecol Obstet Hum Reprod. 2017;46(8):637–42.

    Article  CAS  PubMed  Google Scholar 

  2. 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  PubMed  Google Scholar 

  3. Peled AW, Duralde E, Foster RD, et al. Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72(Suppl 1):S48-52.

    Article  CAS  PubMed  Google Scholar 

  4. 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(3):818–29.

    Article  CAS  PubMed  Google Scholar 

  5. Endara M, Chen D, Verma K, Nahabedian MY, Spear SL. Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis. Plast Reconstr Surg. 2013;132(5):1043–54.

    Article  CAS  PubMed  Google Scholar 

  6. De La Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM. 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(10):3241–9.

    Article  PubMed  Google Scholar 

  7. 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(4):328–38.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peled AW, Wang F, Foster RD, et al. Expanding the indications for total skin-sparing mastectomy: is it safe for patients with locally advanced disease? Ann Surg Oncol. 2016;23(1):87–91.

    Article  PubMed  Google Scholar 

  9. Dent BL, Small K, Swistel A, Talmor M. Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment. Aesthet Surg J. 2014;34(4):560–70.

    Article  PubMed  Google Scholar 

  10. Bozzuto LM, Bartholomew AJ, Sosin M, et al. Surgical complications in nipple-sparing mastectomy: safe in the elderly. J Am Coll Surg. 2018;227(4):e7–8.

    Article  Google Scholar 

  11. Komorowski AL, Zanini V, Regolo L, Carolei A, Wysocki WM, Costa A. Necrotic complications after nipple- and areola-sparing mastectomy. World J Surg. 2006;30(8):1410–3.

    Article  PubMed  Google Scholar 

  12. Society AC. Cancer facts and figures. ACS. Accessed October 20, 2022.

  13. Fortunato L, Loreti A, Cortese G, et al. Regret and quality of life after mastectomy with or without reconstruction. Clin Breast Cancer. 2021;21(3):162–9.

    Article  PubMed  Google Scholar 

  14. Dauplat J, Kwiatkowski F, Rouanet P, et al. Quality of life after mastectomy with or without immediate breast reconstruction. Br J Surg. 2017;104(9):1197–206.

    Article  CAS  PubMed  Google Scholar 

  15. Toyserkani NM, Jørgensen MG, Tabatabaeifar S, Damsgaard T, Sørensen JA. Autologous versus implant-based breast reconstruction: a systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg. 2020;73(2):278–85.

    Article  PubMed  Google Scholar 

  16. Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective Study. J Am Coll Surg. 2016;223(6):745–54.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Girotto JA, Schreiber J, Nahabedian MY. Breast reconstruction in the elderly: preserving excellent quality of life. Ann Plast Surg. 2003;50(6):572–8.

    Article  PubMed  Google Scholar 

  18. Sisco M, Johnson DB, Wang C, Rasinski K, Rundell VL, Yao KA. The quality-of-life benefits of breast reconstruction do not diminish with age. J Surg Oncol. 2015;111(6):663–8.

    Article  PubMed  Google Scholar 

  19. Tesarova P. Breast cancer in the elderly-Should it be treated differently? Rep Pract Oncol Radiother. 2012;18(1):26–33.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gennari R, Curigliano G, Rotmensz N, et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopasual patients. Cancer. 2004;101(6):1302–10.

    Article  PubMed  Google Scholar 

  21. Yin M, Verschraegen C, Vincent VH, Patel SM, George T, Truica CI. Impact of lack of surgery on outcomes in elderly women with nonmetastatic breast cancer-A surveillance, epidemiology, and end results 18 population based study. Medicine (Baltimore). 2020;99(3):e18745.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cortadellas T, Córdoba O, Gascón A, et al. Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution. Eur J Surg Oncol. 2015;41(5):635–40.

    Article  CAS  PubMed  Google Scholar 

  23. Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast reconstruction. Plast Reconstr Surg. 1998;101(7):1810–8.

    Article  CAS  PubMed  Google Scholar 

  24. James R, McCulley SJ, Macmillan RD. Oncoplastic and reconstructive breast surgery in the elderly. Br J Surg. 2015;102(5):480–8.

    Article  CAS  PubMed  Google Scholar 

  25. Hamnett KE, Subramanian A. Breast reconstruction in older patients: a literature review of the decision-making process. J Plast Reconstr Aesthet Surg. 2016;69(10):1325–34.

    Article  CAS  PubMed  Google Scholar 

  26. Parmeshwar N, Piper M, Viner J, Foster R, Kim EA. Evaluation of dual-port versus single-port tissue expanders in postmastectomy breast reconstruction. Plast Reconstr Surg Glob Open. 2021;9(7):e3703.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bonifant H, Holloway S. A review of the effects of ageing on skin integrity and wound healing. Br J Commun Nurs. 2019;24(Sup3):S28–33.

    Article  Google Scholar 

  28. Gould LJ, Fulton AT. Wound healing in older adults. R I Med J (2013). 2016;99(2):34–6.

    PubMed  Google Scholar 

  29. de Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher risk of pressure injury. Biol Rev Camb Philos Soc. 2022;97(3):874–95.

    Article  PubMed  Google Scholar 

  30. Gosain A, DiPietro LA. Aging and wound healing. World J Surg. 2004;28(3):321–6.

    Article  PubMed  Google Scholar 

  31. Sgonc R, Gruber J. Age-related aspects of cutaneous wound healing: a mini-review. Gerontology. 2013;59(2):159–64.

    Article  PubMed  Google Scholar 

  32. Algaithy ZK, Petit JY, Lohsiriwat V, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012;38(2):125–9.

    Article  CAS  PubMed  Google Scholar 

  33. Holland M, Wallace A, Viner J, Sbitany H, Piper M. Safety of incision placement with nipple-sparing mastectomy and immediate prepectoral breast reconstruction. Plast Reconstr Surg Glob Open. 2023;11(1):e4736.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rusby JE, Smith BL, Gui GP. Nipple-sparing mastectomy. Br J Surg. 2010;97(3):305–16.

    Article  CAS  PubMed  Google Scholar 

  35. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Vacas S, Cole DJ, Cannesson M. Cognitive decline associated with anesthesia and surgery in older patients. JAMA. 2021.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Schenning KJ, Deiner SG. Postoperative delirium in the geriatric patient. Anesthesiol Clin. 2015;33(3):505–16.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nisha Parmeshwar MD.

Ethics declarations


The authors have no disclosures to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parmeshwar, N., Dugan, C.L., Barnes, L.L. et al. Nipple-Sparing Mastectomies in Patients over the Age of 60 Years: Factors Associated with Surgical Outcomes. Ann Surg Oncol 30, 8428–8435 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: