Skip to main content

Advertisement

SpringerLink
Log in

Recurrence Outcomes After Nipple-Sparing Mastectomy and Immediate Breast Reconstruction in Patients with Pure Ductal Carcinoma In Situ

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

Abstract

Background

Nipple-sparing mastectomy (NSM) has become increasingly prevalent for patients with ductal carcinoma in situ (DCIS) requiring mastectomy. However, few data regarding recurrence outcomes after NSM are available for this patient population. This study evaluated the locoregional recurrence (LRR) rate for patients with pure DCIS who underwent NSM followed by immediate breast reconstruction without adjuvant radiotherapy and investigated potential risk factors for LRR and/or nipple-areola complex recurrence (NR).

Methods

A retrospective chart review was performed for 199 consecutive patients with pure DCIS who underwent NSM and immediate breast reconstruction between March 2003 and December 2015. Risk factors for LRR and NR were analyzed using univariate (Chi square test) and multivariate (Cox model) methods.

Results

The median follow-up duration after surgery was 97 months (range, 39–186 months). At 10 years, the LRR rate was 4.5%, and the NR rate was 3%. The univariate analysis showed that high nuclear grade, negative receptor status, positive human epidermal growth factor receptor 2 (HER2) status, and negative hormone receptor/positive HER2 subtype were associated with increased risk for NR. The multivariate analysis demonstrated that negative progesterone receptor status was an independent risk factor for LRR. However, margin status and tumor-to-nipple distance (TND) were not associated with increased risk for either LRR or NR.

Conclusions

The study findings suggest that NSM can be a feasible surgical option even for DCIS with a TND of 1 cm or less if the retroareolar resection margin is negative for malignancy. Determining the molecular subtype of DCIS might be helpful in identifying patients at high risk for recurrence.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kang SY, Kim YS, Kim Z, et al. Basic findings regarding breast cancer in Korea in 2015: data from a breast cancer registry. J Breast Cancer. 2018;21:1–10.

    PubMed  PubMed Central  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.

    PubMed  Google Scholar 

  3. Worni M, Akushevich I, Greenup R, et al. Trends in treatment patterns and outcomes for ductal carcinoma in situ. J Natl Cancer Inst. 2015;107:djv263.

    PubMed  PubMed Central  Google Scholar 

  4. Silverstein MJ, Barth A, Poller DN, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer. 1995;31A:1425–7.

    CAS  PubMed  Google Scholar 

  5. Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst. 2018;110:157–65.

    Google Scholar 

  6. Bailey CR, Ogbuagu O, Baltodano PA, et al. Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction. Plast Reconstr Surg. 2017;140:219–26.

    CAS  PubMed  Google Scholar 

  7. Frey JD, Alperovich M, Kim JC, et al. Oncologic outcomes after nipple-sparing mastectomy: a single-institution experience. J Surg Oncol. 2016;113:8–11.

    PubMed  Google Scholar 

  8. Adam H, Bygdeson M, de Boniface J. The oncological safety of nipple-sparing mastectomy: a Swedish matched-cohort study. Eur J Surg Oncol. 2014;40:1209–15.

    CAS  PubMed  Google Scholar 

  9. Poruk KE, Ying J, Chidester JR, et al. Breast cancer recurrence after nipple-sparing mastectomy: one institution’s experience. Am J Surg. 2015;209:212–7.

    PubMed  Google Scholar 

  10. Orzalesi L, Casella D, Santi C, et al. Nipple-sparing mastectomy: surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six-year period. Breast. 2016;25:75–81.

    PubMed  Google Scholar 

  11. Smith BL, Tang R, Rai U, et al. Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg. 2017;225:361–5.

    PubMed  Google Scholar 

  12. Moo TA, Pinchinat T, Mays S, et al. Oncologic outcomes after nipple-sparing mastectomy. Ann Surg Oncol. 2016;23:3221–5.

    PubMed  Google Scholar 

  13. Shimo A, Tsugawa K, Tsuchiya S, et al. Oncologic outcomes and technical considerations of nipple-sparing mastectomies in breast cancer: experience of 425 cases from a single institution. Breast Cancer Auckl. 2016;23:851–60.

    Google Scholar 

  14. Wang F, Peled AW, Garwood E, et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21:3223–30.

    PubMed  Google Scholar 

  15. 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;22:3241–9.

    Google Scholar 

  16. Sisco M, Kyrillos AM, Lapin BR, Wang CE, Yao KA. Trends and variation in the use of nipple-sparing mastectomy for breast cancer in the United States. Breast Cancer Res Treat. 2016;160:111–20.

    PubMed  Google Scholar 

  17. Mota BS, Riera R, Ricci MD, et al. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev. 2016;11:CD008932.

    PubMed  Google Scholar 

  18. Galimberti V, Morigi C, Bagnardi V, et al. Oncological outcomes of nipple-sparing mastectomy: a single-center experience of 1989 patients. Ann Surg Oncol. 2018;25:3849–57.

    PubMed  Google Scholar 

  19. Chan LW, Rabban J, Hwang ES, et al. Is radiation indicated in patients with ductal carcinoma in situ and close or positive mastectomy margins? Int J Radiat Oncol Biol Phys. 2011;80:25–30.

    PubMed  Google Scholar 

  20. Chadha M, Portenoy J, Boolbol SK, Gillego A, Harrison LB. Is there a role for postmastectomy radiation therapy in ductal carcinoma in situ? Int J Surg Oncol. 2012;2012:423520.

    PubMed  PubMed Central  Google Scholar 

  21. Owen D, Tyldesley S, Alexander C, et al. Outcomes in patients treated with mastectomy for ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2013;85:e129–34.

    PubMed  Google Scholar 

  22. Fitzsullivan E, Lari SA, Smith B, et al. Incidence and consequence of close margins in patients with ductal carcinoma in situ treated with mastectomy: is further therapy warranted? Ann Surg Oncol. 2013;20:4103–12.

    PubMed  PubMed Central  Google Scholar 

  23. Stuart KE, Houssami N, Taylor R, Hayen A, Boyages J. Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review, meta-analysis, and meta-regression analysis. BMC Cancer. 2015;15:890.

    PubMed  PubMed Central  Google Scholar 

  24. Carlson GW, Page A, Johnson E, Nicholson K, Styblo TM, Wood WC. Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy. J Am Coll Surg. 2007;204:1074–8; discussion 1078–80.

    PubMed  Google Scholar 

  25. Lhenaff M, de Lara CT, Fournier M, et al. A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast. Eur J Surg Oncol. 2019;45:950–5.

    PubMed  Google Scholar 

  26. Timbrell S, Al-Himdani S, Shaw O, Tan K, Morris J, Bundred N. Comparison of local recurrence after simple and skin-sparing mastectomy performed in patients with ductal carcinoma in situ. Ann Surg Oncol. 2017;24:1071–6.

    PubMed  Google Scholar 

  27. Lago V, Maisto V, Gimenez-Climent J, Vila J, Vazquez C, Estevan R. Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: a 10-year follow-up study. Breast J. 2018;24:298–303.

    PubMed  Google Scholar 

  28. Leclère FM, Panet-Spallina J, Kolb F, et al. Nipple-sparing mastectomy and immediate reconstruction in ductal carcinoma in situ: a critical assessment with 41 patients. Aesthetic Plast Surg. 2014;38:338–43.

    PubMed  Google Scholar 

  29. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1:888–96.

    PubMed  Google Scholar 

  30. Solin LJ, Fourquet A, Vicini FA, et al. Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2005;103:1137–46.

    PubMed  Google Scholar 

  31. Mele A, Mehta P, Slanetz PJ, Brook A, Recht A, Sharma R. Breast-conserving surgery alone for ductal carcinoma in situ: factors associated with increased risk of local recurrence. Ann Surg Oncol. 2017;24:1221–6.

    PubMed  Google Scholar 

  32. Rashtian A, Iganej S, Amy Liu IL, Natarajan S. Close or positive margins after mastectomy for DCIS: pattern of relapse and potential indications for radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:1016–20.

    PubMed  Google Scholar 

  33. Klein J, Kong I, Paszat L, et al. Close or positive resection margins are not associated with an increased risk of chest wall recurrence in women with DCIS treated by mastectomy: a population-based analysis. Springerplus. 2015;4:335.

    PubMed  PubMed Central  Google Scholar 

  34. Brachtel EF, Rusby JE, Michaelson JS, et al. Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol. 2009;27:4948–54.

    PubMed  Google Scholar 

  35. Zhang H, Li Y, Moran MS, Haffty BG, Yang Q. Predictive factors of nipple involvement in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2015;151:239–49.

    CAS  PubMed  Google Scholar 

  36. Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2009;114:97–101.

    CAS  PubMed  Google Scholar 

  37. D’Alonzo M, Martincich L, Biglia N, et al. Clinical and radiological predictors of nipple-areola complex involvement in breast cancer patients. Eur J Cancer. 2012;48:2311–8.

    PubMed  Google Scholar 

  38. Williams KE, Barnes NL, Cramer A, et al. Molecular phenotypes of DCIS predict overall and invasive recurrence. Ann Oncol. 2015;26:1019–25.

    CAS  PubMed  Google Scholar 

  39. Rakovitch E, Nofech-Mozes S, Hanna W, et al. HER2/neu and Ki-67 expression predict noninvasive recurrence following breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. 2012;106:1160–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Cornfield DB, Palazzo JP, Schwartz GF, et al. The prognostic significance of multiple morphologic features and biologic markers in ductal carcinoma in situ of the breast: a study of a large cohort of patients treated with surgery alone. Cancer. 2004;100:2317–27.

    PubMed  Google Scholar 

  41. Zhang X, Dai H, Liu B, Song F, Chen K. Predictors for local invasive recurrence of ductal carcinoma in situ of the breast: a meta-analysis. Eur J Cancer Prev. 2016;25:19–28.

    CAS  PubMed  Google Scholar 

  42. Poulakaki N, Makris GM, Battista MJ, et al. Hormonal receptor status, Ki-67 and HER2 expression: prognostic value in the recurrence of ductal carcinoma in situ of the breast? Breast. 2016;25:57–61.

    PubMed  Google Scholar 

  43. Kantor O, Winchester DJ. Breast-conserving therapy for DCIS: does size matter? J Surg Oncol. 2014;110:75–81.

    PubMed  Google Scholar 

  44. Wu ZY, Kim HJ, Lee JW, et al. Breast cancer recurrence in the nipple-areola complex after nipple-sparing mastectomy with immediate breast reconstruction for invasive breast cancer. JAMA Surg. 2019;154(11):1030–7.

    Google Scholar 

  45. Petit JY, Veronesi U, Orecchia R, et al. Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia. Ann Oncol. 2012;23:2053–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea

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

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

    Zhen Yu Wu MD, PhD

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

    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

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

    Gyung-Yub 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

Authors
  1. Zhen Yu Wu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hee-Jeong Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JongWon Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Il-Yong Chung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji-Sun Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sae-Byul Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Byung Ho Son MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jin-Sup Eom MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sung-Bae Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gyung-Yub Gong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hak-Hee Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sei Hyun Ahn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. BeomSeok Ko MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to BeomSeok Ko MD, PhD.

Ethics declarations

Disclosure

There are no conflicts of interests.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, Z.Y., Kim, HJ., Lee, J. et al. Recurrence Outcomes After Nipple-Sparing Mastectomy and Immediate Breast Reconstruction in Patients with Pure Ductal Carcinoma In Situ. Ann Surg Oncol 27, 1627–1635 (2020). https://doi.org/10.1245/s10434-019-08184-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-08184-z

Search

Navigation