Introduction/Background Even though breast conserving therapy has become the gold standard surgical treatment for breast cancer, in our institution 34.7% of the patients still undergo mastectomy. Nipple sparing mastectomy(NSM) is becoming widely accepted, particularly in those patients that undergo prophylactic surgery with reconstruction, due to its superior cosmetic results. NSM can also be used in highly selected cancer patients as an effective procedure if it does not compromise oncologic safety.
Methodology Literature review of the nipple areola complex (NAC) sparing mastectomy on prophylactic and breast cancer management. Additionally we evaluate the impact it would have in our referral centre, selecting patients, among those who underwent a mastectomy between 2015–2018, according to the inclusion criteria of the National Comprehensive Cancer Network (NCCN) 2017 Guidelines.
Results There are no randomized trials of NSM. Long-term follow-up in clinical series is limited and most of the studies’ samples are heterogeneous. The available data shows an overall survival of over 90% and local disease recurrence of 3–4.6%.
2017 NCCN Guidelines suggest the use of NSM in patients with early-stage tumours, biologically favourable carcinomas and infiltrating ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS) that are >2cm from the nipple. Despite total removal of glandular breast tissue and the low rate of recurrence and/or nipple involvement expected, assessment of nipple free margins should be mandatory to reduce the risk of occult NAC involvement.
In our Institution (H.U.12 de Octubre, Madrid) 178 mastectomies were performed for breast cancer treatment and 18 for risk reduction between 2015–2018. According to the inclusion criteria of the NCCN Guidelines, 57 patients (29%) could have undergone a NSM (27 patients with IDC, 12 with DCIS and 18 BRCA mutation carriers).
Conclusion NSM has become a subject of increased attention. It’s a safe option of treatment in patients with early-stage tumours and biologically favourable carcinomas.
Disclosure Prospective trials, with long-term follow up and homogenous samples are needed to establish the inclusion criteria and management of this patients: pathologic factors (tumour stage, molecular subtypes…), preoperative imaging study, safety distance of the tumour to the nipple, surgical technique, intraoperative study of the NAC (frozen section examination), and role of radiotherapy. The authors declare that there is no conflict of interest.
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