Feasibility study of nipple-sparing mastectomy for Japanese breast cancer patients.

Abstract

166 Background: Nipple-sparing mastectomy (NSM) has been gathering increased recognition as an alternative to more traditional mastectomy approaches. However, the oncological safety of these procedures is still to be elucidated. The purpose of this study is to investigate technical feasibility of NSM without increasing the risk of local recurrence and complications. Methods: Ninety-eight stage 0-III breast cancer patients received NSM between January 2001 and April 2012 at Keio University Hospital. Eligible patients were without skin involvement and not indicated for breast-conserving therapy by preoperative imaging. The pathological analysis of the subareolar tissue was performed and nipple-areolar-complex (NAC) would be removed if positive. Four hundred seventy-four breast cancer patients who had mastectomy during the same period were used as a control group. Results: The median age was 46.0 years (range 29–68). The mean clinical tumor size was 2.8±1.2cm and the mean distance between the nipple and the tumor was 2.5±1.7cm. Ninety-one patients (92.9%) had clinically node-negative status. NAC involvement was observed in 3 patients (3.1%). Three patients (3.1%) presented with epidermal necrosis. After a median follow-up period of 37.3 months (range 1-136), there were 7 recurrences (7.1%), including 4 local recurrences (4.1%) and 3 distant metastases (3.1%). There was no statistically significant difference in local recurrence between the patients with NSM and mastectomy (4.1% vs. 3.2%; p=0.16). Immediate and delayed reconstruction was performed in 2 cases (2.0%) and 41 cases (41.8%), respectively. Conclusions: Our results suggested NSM may provide oncologic safety for strongly motivated and carefully selected patients.