Narrative review of the application of radiotherapy in nipple-areola-complex–sparing mastectomy

Abstract

: In the treatment of breast cancer, the effective removal of the tumor was once the sole aim of surgery. However, the goals of breast cancer surgery have shifted, with considerable emphasis now placed on improving the appearance and function of the breast while leaving the curative effect unaffected or even improved. Nipple-areola-complex-sparing mastectomy (NSM) facilitates breast reconstruction by preserving the skin and nipple-areola complex (NAC) of the breast. In recent years, this approach has become increasingly popular; however, it still carries a high risk of local recurrence in the NAC. Therefore, for patients who NSM, adjuvant radiotherapy (RT) is recommended. Although adjuvant radiation therapy is the standard of care for breast cancer treatment following lumpectomy, the application of RT after NSM is controversial. Previous studies on the roles of pre-, intra-, and/or postoperative RT combined with NSM have produced inconsistent results. Conventional preoperative or postoperative RT for breast cancer can cause contracture deformation of the implanted prosthesis. The emergence of intraoperative RT technology has further optimized radiotherapy-assisted NSM combined with breast reconstruction as a therapeutic strategy for breast cancer. The main complications of this treatment include fat necrosis, radiation fibrosis, and prosthesis contracture. Based on the selection of suitable patients, adjuvant RT is applied in combination with NSM according to the risk of local disease recurrence. In this article, we review the application of RT in NSM and compare studies on NSM combined with pre-, intra-, and/or postoperative RT.