Nipple-Sparing mastectomy: Critical assessment of 51 procedures and implications for selection criteria

Anna M. Voltura, Theodore N. Tsangaris, Gedge David Rosson, Lisa Jacobs, Jaime I. Flores, Navin K Singh, Pedram Argani, Charles M. Balch

Research output: Contribution to journalArticle

Abstract

Background: Retrospective studies have shown that occult nipple-areolar complex (NAC) involvement in breast cancer is low, occurring in 6-10% of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-sparing mastectomy (NSM) has prompted further evaluation of the oncologic safety of this procedure. Methods: We conducted a retrospective chart review of 36 self-selected patients who underwent 51 NSM procedures between 2002 and 2007. Criterion for patient selection was no clinical evidence of nipple-areolar tumor involvement. All patients had the base of the NAC evaluated for occult tumor by permanent histologic section assessment. We also evaluated tumor size, location, axillary node status, recurrence rate, and cosmetic result. Results: Malignant NAC involvement was found in 2 of 34 NSM (5.9%) completed for cancer which prompted subsequent removal of the NAC. Of the 51 NSM, 17 were for prophylaxis, 10 for ductal carcinoma in situ (DCIS), and 24 for invasive cancer. The average tumor size was 2.8 cm for invasive cancer and 2.5 cm for DCIS. Nine patients had positive axillary nodes. Overall, 94% of the tumors were located peripherally in the breast. After mean follow-up of 18 months, only two patients (5.9%) had local recurrence. Conclusion: Using careful patient selection and careful pathological evaluation of the subareolar breast tissue at surgery, NSM can be an oncologically safe procedure in patients where this is important to their quality of life. A prospective study based on focused selection criteria and long-term follow-up is currently in progress.

Original languageEnglish (US)
Pages (from-to)3396-3401
Number of pages6
JournalAnnals of Surgical Oncology
Volume15
Issue number12
DOIs
StatePublished - Dec 2008

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Nipples
Mastectomy
Patient Selection
Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Cosmetics
Breast
Recurrence
Patient Satisfaction
Retrospective Studies
Quality of Life
Prospective Studies
Breast Neoplasms
Safety
Skin

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Nipple-Sparing mastectomy : Critical assessment of 51 procedures and implications for selection criteria. / Voltura, Anna M.; Tsangaris, Theodore N.; Rosson, Gedge David; Jacobs, Lisa; Flores, Jaime I.; Singh, Navin K; Argani, Pedram; Balch, Charles M.

In: Annals of Surgical Oncology, Vol. 15, No. 12, 12.2008, p. 3396-3401.

Research output: Contribution to journalArticle

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abstract = "Background: Retrospective studies have shown that occult nipple-areolar complex (NAC) involvement in breast cancer is low, occurring in 6-10{\%} of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-sparing mastectomy (NSM) has prompted further evaluation of the oncologic safety of this procedure. Methods: We conducted a retrospective chart review of 36 self-selected patients who underwent 51 NSM procedures between 2002 and 2007. Criterion for patient selection was no clinical evidence of nipple-areolar tumor involvement. All patients had the base of the NAC evaluated for occult tumor by permanent histologic section assessment. We also evaluated tumor size, location, axillary node status, recurrence rate, and cosmetic result. Results: Malignant NAC involvement was found in 2 of 34 NSM (5.9{\%}) completed for cancer which prompted subsequent removal of the NAC. Of the 51 NSM, 17 were for prophylaxis, 10 for ductal carcinoma in situ (DCIS), and 24 for invasive cancer. The average tumor size was 2.8 cm for invasive cancer and 2.5 cm for DCIS. Nine patients had positive axillary nodes. Overall, 94{\%} of the tumors were located peripherally in the breast. After mean follow-up of 18 months, only two patients (5.9{\%}) had local recurrence. Conclusion: Using careful patient selection and careful pathological evaluation of the subareolar breast tissue at surgery, NSM can be an oncologically safe procedure in patients where this is important to their quality of life. A prospective study based on focused selection criteria and long-term follow-up is currently in progress.",
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AU - Jacobs, Lisa

AU - Flores, Jaime I.

AU - Singh, Navin K

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N2 - Background: Retrospective studies have shown that occult nipple-areolar complex (NAC) involvement in breast cancer is low, occurring in 6-10% of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-sparing mastectomy (NSM) has prompted further evaluation of the oncologic safety of this procedure. Methods: We conducted a retrospective chart review of 36 self-selected patients who underwent 51 NSM procedures between 2002 and 2007. Criterion for patient selection was no clinical evidence of nipple-areolar tumor involvement. All patients had the base of the NAC evaluated for occult tumor by permanent histologic section assessment. We also evaluated tumor size, location, axillary node status, recurrence rate, and cosmetic result. Results: Malignant NAC involvement was found in 2 of 34 NSM (5.9%) completed for cancer which prompted subsequent removal of the NAC. Of the 51 NSM, 17 were for prophylaxis, 10 for ductal carcinoma in situ (DCIS), and 24 for invasive cancer. The average tumor size was 2.8 cm for invasive cancer and 2.5 cm for DCIS. Nine patients had positive axillary nodes. Overall, 94% of the tumors were located peripherally in the breast. After mean follow-up of 18 months, only two patients (5.9%) had local recurrence. Conclusion: Using careful patient selection and careful pathological evaluation of the subareolar breast tissue at surgery, NSM can be an oncologically safe procedure in patients where this is important to their quality of life. A prospective study based on focused selection criteria and long-term follow-up is currently in progress.

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