Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction: Oncologic or Technical Problem?
Top Cited Papers
- 11 September 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 203 (5), 704-714
- https://doi.org/10.1016/j.jamcollsurg.2006.07.015
Abstract
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. 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. 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. 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.This publication has 38 references indexed in Scilit:
- Nipple-Sparing MastectomyArchives of Surgery, 2004
- Skin-Sparing Mastectomy with Conservation of the Nipple–Areola Complex and Autologous Reconstruction is an Oncologically Safe ProcedureAnnals of Surgery, 2003
- The nipple-sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated.Tumori Journal, 2003
- Efficacy of Bilateral Prophylactic Mastectomy in BRCA1 and BRCA2 Gene Mutation CarriersJNCI Journal of the National Cancer Institute, 2001
- Nipple-sparing mastectomy in breast cancer: a viable option?European Journal of Surgical Oncology, 2001
- The Incidence of Occult Nipple-Areola Complex Involvement in Breast Cancer Patients Receiving a Skin-Sparing MastectomyAnnals of Surgical Oncology, 1999
- Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast CancerNew England Journal of Medicine, 1999
- A Comparison of Outcomes Using Three Different Methods of Breast ReconstructionPlastic and Reconstructive Surgery, 1992
- Surgical complications and follow-up evaluation of 163 patients with subcutaneous mastectomyAesthetic Plastic Surgery, 1987
- Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancerInternational Journal of Radiation Oncology*Biology*Physics, 1985