Comparison between Nipple-Areola Saving Subcutaneous Mastectomy and Conventional Subcutaneous Mastectomy in Local Relapse and Prognosis: 5 Year Follow-Up Results.

Abstract

Abstract Backgrounds: Skin-sparing mastectomy (SSM) and the even more conservative nipple-areola-skin sparing mastectomy (NASSM) are surgical options for selected patients with indication for mastectomy. But long term result of NASSM is rare and there is no report in Korea. So, we report here 5-year follow-up results of NASSM.Materials and Methods: 202 patients who underwent SSM (N=67) or NASSM (N=135) for breast cancer at our institution between 1996 and 2006 were included in analysis. All patients were followed-up completely. For making a decision of preserving the nipple-areola complex (NAC) during operation, frozen section analysis of the retroareolar glandular tissue with precise localization was done after meticulous dissection of parenchyme under the areola. In the case of positive result in the frozen section or final histology in the NAC, NAC was sacrificed. Intra- or postoperative radiotherapy was not performed. Local relapse (LR) rate and disease free survival (DFS) was analyzed and compared the result between NASSM and SSM.Results: The mean age at diagnosis was 40.2 years old (range 24-65) and mean follow-up months of NASSM was 70.9 months and 60.5 months in SSM. 60 NACs (29.7%) of the all objective NACs were involved by cancer cell at the final histology. The cancer cell involvement to the NAC were more common in invasive carcinoma with extensive intraductal component (p<0.001) or ductal carcinoma in situ component (p=0.048). But tumor size, vascular invasion and nodal status did not affect to involvement of the cancer cell in the NAC. Local recurrences occurred in 8.9% (NASSM) and 6.0% (SSM) of all patients, but there was no significant correlation between the two procedures (p>0.05). Local recurrences occurred at NAC (8 cases), skin flap (3 cases) and chest wall (1 cases) in NASSM procedure group, and 4 skin flaps in SSM group. All NAC recurrences were treated by wide excision of NAC. After treatment of local recurrence, only one case of SSM group preceded to distant metastasis. 5 year Disease-free survival rate was 88.2% in NASSM and 88.4% in SSM group (p>0.05).Conclusion: Our long term follow-up study shows that Nipple-areola-skin sparing mastectomy is oncologically safe procedure for breast cancer in patients who are candidates for mastectomy. Even if relapse is occurred in the NAC, this recurrence cannot affect to the progression of relapse after adequate local treatment. Thus, NASSM is alternative method for SSM with oncological safety and better cosmetic outcome. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3105.