Nipple-sparing mastectomy with immediate reconstruction is safe oncologically

NEW YORK (Reuters Health) - Nipple areola skin-sparing mastectomy with immediate reconstruction does not increase breast cancer recurrence compared to standard surgery, Korean researchers say in the March Annals of Surgery.

"Local recurrence rates to date appear to be low, even with stage 2 or 3 disease, and nipple areola complex preservation is the optimal cosmetic outcome in breast cancer treatment," senior author Dr. Sei Hyun Ahn from Asan Medical Center in Seoul told Reuters Health by email.

Dr. Ahn and colleagues compared oncological and technical outcomes in 368 women who had skin-sparing mastectomy and 152 who had nipple areola skin-sparing mastectomy and immediate reconstruction (with a transverse rectus abdominis musculocutaneous flap).

At 5 years, recurrence-free survival was 89% with nipple-areola preservation and 87.2% for skin-sparing surgery, and overall survival was 97.1% with nipple sparing and 95.8% with skin sparing.

When they looked at local recurrences, the researchers included an additional group of 1190 women who had modified radical mastectomy. The local recurrence rate was 2% with nipple-sparing surgery, 0.8% with skin-sparing mastectomy, and 0.9% with modified radical mastectomy (p = 0.2). Local recurrence did not affect overall survival, the authors said.

After controlling for patient and tumor characteristics, surgical method was not associated with disease-free or overall survival when nipple- and skin-sparing approaches were compared.

One hundred fifteen women who had nipple areola sparing mastectomies were followed prospectively for surgical complications. Eleven developed complete nipple-areolar necrosis, and 15 (including 1 of 7 women who had radiotherapy) had partial nipple-areolar necrosis.

The investigators plan to investigate the safety of nipple areola complex preservation in women treated with chemotherapy before surgery. Up to now, "not many people" have had nipple areola skin-sparing mastectomy after neoadjuvant chemotherapy, Dr. Ahn said.

"We should consider the quality of life for patients, not only focusing the removal of the cancer tissue," Dr. Ahn concluded.

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