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Increasing Eligibility for Nipple-Sparing Mastectomy

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

Abstract

Background

Eligibility for nipple-sparing mastectomy (NSM) varies widely on the basis of patient and tumor factors.

Methods

Review of patients undergoing NSM from June 2007 to December 2012 at our institution was performed. Patient and tumor characteristics, complications, and recurrences were collected. NSM from 2007 to 2010 and 2011 to 2012 were compared to assess trends in eligibility and outcomes over time.

Results

NSM was performed on 645 breasts in 370 patients. Indications were risk reduction in 330 (51.2 %), invasive cancer in 226 (35.0 %), and ductal carcinoma-in situ in 89 (13.8 %) breasts. Fifty-one (13.8 %) patients had positive lymph nodes. Twenty-seven (7.3 %) patients received neoadjuvant chemotherapy. Forty-eight (7.4 %) breasts had prior radiotherapy. Total nipple necrosis occurred in 11 (1.7 %) breasts. Twenty-four (3.7 %) breasts had nipples removed as a result of positive subareolar/nipple margins. At 22 months’ mean follow-up, local recurrence occurred in 4 of 156 (2.6 %) breasts operated on for cancer through 2011. No recurrences involved the nipple. NSM performed in 2011–2012 (n = 475) compared to 2007–2010 (n = 170), were more often for cancer, in patients with higher body mass index, and on larger breasts (p < 0.001). There was no significant difference in total nipple necrosis rates between groups. Nipple loss due to positive subareolar/nipple margins was significantly less in 2011–2012 (p = 0.027).

Conclusions

Eligibility for NSM has expanded to include women with higher body mass index and larger breasts, with no increase in nipple loss due to ischemia. Rates of positive subareolar margins have decreased over time, even though NSM is being performed more frequently for cancer, suggesting improved patient selection.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Suzanne B. Coopey MD, Rong Tang MD, Lan Lei MD, Kari Kansal MD, Michele A. Gadd MD, Michelle C. Specht MD & Barbara L. Smith MD, PhD

  2. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Phoebe E. Freer MD

  3. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA

    Amy S. Colwell MD & William G. Austen Jr. MD

Authors
  1. Suzanne B. Coopey MD
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  2. Rong Tang MD
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  3. Lan Lei MD
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  4. Phoebe E. Freer MD
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  5. Kari Kansal MD
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  6. Amy S. Colwell MD
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  7. Michele A. Gadd MD
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  8. Michelle C. Specht MD
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  9. William G. Austen Jr. MD
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  10. Barbara L. Smith MD, PhD
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Corresponding author

Correspondence to Barbara L. Smith MD, PhD.

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Coopey, S.B., Tang, R., Lei, L. et al. Increasing Eligibility for Nipple-Sparing Mastectomy. Ann Surg Oncol 20, 3218–3222 (2013). https://doi.org/10.1245/s10434-013-3152-x

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  • DOI: https://doi.org/10.1245/s10434-013-3152-x

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