A recent study published in Plastic and Reconstructive Surgery confirms that nipple-sparing mastectomy (NSM) is a very safe procedure when performed in appropriate patients. Preserving the nipple-areola complex at the time of a mastectomy is associated with a very low risk of recurrence, just over 3%.
“Nipple-sparing mastectomy remains a viable option in the appropriately indicated patient with regards to long-term cancer recurrence,” state the researchers.
A nipple-sparing mastectomy (NSM) preserves the nipple and areola along with the entire skin envelope. Only the underlying breast glandular tissue is removed. Nipple-sparing mastectomy significantly improves cosmetic results when combined with immediate breast reconstruction and is oncologically safe when performed in appropriate candidates. It can also improve the return of sensation in some patients.
120 patients undergoing nipple-sparing mastectomy for breast cancer treatment were evaluated for breast cancer outcomes. The analysis included a total of 126 therapeutic NSM procedures. Prophylactic (preventive) NSM procedures to reduce the risk of breast cancer in women at high genetic risk were excluded.
At a median follow-up of 10 years after NSM, the analysis showed a very low risk of recurrent cancer: 3.33% per patient and 3.17% per reconstructed breast. Of the four patients who developed a recurrence, two had local recurrences (breast-only) and two had cancer spread beyo0nd their breast (locoregional recurrence).
The recurrence risk was higher in women who’s initial cancer involved the lymph nodes. However, there were no demographic, surgical, or tumor-related variables that predicted the risk of recurrent breast cancer.
The confirmation of favorable long-term cancer control is crucial because of the increased use of NSM and immediate reconstruction in women with breast cancer. “Patients with nipple-sparing mastectomies have had low locoregional recurrence rates in a retrospective review of patients with a median follow-up of 10 years,” researchers conclude. “Despite low rates of recurrence, close surveillance remains important to continually assess for long-term safety of nipple-sparing mastectomy.”
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Nipple-sparing mastectomy (NSM) is the latest evolution in mastectomy technique. The procedure preserves the entire skin envelope and nipple-areola. Only the underlying breast tissue is removed. Nipple-sparing mastectomy significantly improves cosmetic results when combined with immediate breast reconstruction, and is oncologically safe when performed in appropriate candidates. It can also improve the return of sensation in some patients.
However, certain factors such as large breast size and a low nipple location can increase the risk of complications such as partial or even complete necrosis of the nipple and areola. There is some good news though for patients choosing NSM to decrease their risk of getting breast cancer (“prophylactic” or “risk-reducing” NSM)… “Staged” surgery with a breast reduction performed at least three months before the NSM significantly decreases these complications in patients with larger breasts.
According to a study published in Plastic and Reconstructive Surgery that compared the staged approach with the traditional all-in-one surgery, staged surgery patients experienced no major skin or nipple-areola necrosis. However, patients who did not reduce their breast size via a breast reduction before having their NSM and immediate reconstruction experienced major necrosis 22% of the time.
The staged approach allows surgeons to reduce the patient’s overall breast size, remove excess skin, and reposition the nipple-areola before the definitive NSM and reconstruction. By decreasing the overall size of the breast and relocating the nipple-areola to a more favorable position ahead of time, the demands on the blood supply at the time of the NSM are significantly reduced. This in turn decreases the risk of complications.
Staging does add an addition surgery and cost, along with a longer overall recovery period, but should be considered in patients who may otherwise not be good candidates for risk-reducing NSM due to large breast size or a low-lying nipple-areola. Patients with a cancer diagnosis are usually not candidates for this staged approach due to the delay it adds to treatment of the cancer.