Nipple-sparing mastectomy for breast cancer and risk reduction: Oncologic or technical problem? Journal Article

Authors: Sacchini, V.; Pinotti, J. A.; Barros, A. C. S. D.; Luini, A.; Pluchinotta, A.; Pinotti, M.; Boratto, M. G.; Ricci, M. D.; Ruiz, C. A.; Nisida, A. C.; Veronesi, P.; Petit, J.; Arnone, P.; Bassi, F.; Disa, J. J.; Garcia-Etienne, C. A.; Borgen, P. I.
Article Title: Nipple-sparing mastectomy for breast cancer and risk reduction: Oncologic or technical problem?
Abstract: Background: We evaluated the risks and benefits of nipple-sparing mastectomy in a multiinstitutional experience in the settings of risk-reducing surgery and breast cancer treatment. Study Design: We analyzed data on 123 patients who had undergone nipple-sparing mastectomy with breast reconstruction for prophylaxis (n = 55), treatment of breast cancer (n = 41), or both (n = 27) at four large centers. Results: Median patient age was 45 years (range 22 to 70 years). There were 192 procedures (69 bilateral, 54 unilateral). Forty-four patients had invasive cancer; 20 had ductal carcinoma in situ (DCIS); 4 had phyllodes tumor. In all of these patients, the nipple tissue was cancer free on pathologic review. Median followup was 24.6 months (range 2.0 to 570.4 months). Local recurrence developed in two patients: one had DCIS in the upper-outer quadrant, with 71.8 months of followup; the other's cancer was invasive, in the upper-outer quadrant, with 6 months of followup. Distant metastasis developed in a third patient, who died 50 months after the procedure. Breast cancer developed in two patients after prophylactic mastectomy: one in the upper-outer quadrant at 61.8 months; one in the axillary tail at 24.4 months. No patients had recurrences in the nipple-areolar complex. Necrosis of the nipple was reported in 22 of 192 patients (11%) and it was judged minimal (less than one-third total skin of nipple) in 13 of 22 patients (59%). Overall cosmesis was judged by the patient and surgeon as good to excellent in the majority of patients. Level of satisfaction with cosmetic results was similar between prophylactic and treatment patients. Conclusions: The risk of local relapse was very low in our series of nipple-sparing mastectomies performed for DCIS or invasive cancer. Nipple-sparing mastectomy in the risk-reducing and breast cancer-treatment settings may be feasible in selected patients and should be the subject of additional prospective clinical trials. © 2006 American College of Surgeons.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; patient satisfaction; cancer surgery; retrospective studies; cancer recurrence; risk benefit analysis; follow up; metastasis; neoplasm recurrence, local; breast cancer; phyllodes tumor; cystosarcoma phylloides; mastectomy; breast neoplasms; mammaplasty; necrosis; cancer therapy; cancer mortality; risk assessment; postoperative complication; cancer invasion; carcinoma in situ; nipple; nipples; risk reduction; breast carcinogenesis; carcinoma, intraductal, noninfiltrating
Journal Title: Journal of the American College of Surgeons
Volume: 203
Issue: 5
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2006-11-01
Start Page: 704
End Page: 714
Language: English
DOI: 10.1016/j.jamcollsurg.2006.07.015
PUBMED: 17084333
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 79" - "Export Date: 4 June 2012" - "CODEN: JACSE" - "Source: Scopus"
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MSK Authors
  1. Joseph Disa
    206 Disa
  2. Patrick I Borgen
    244 Borgen