P2-15-03: Nipple-Sparing Mastectomy for Breast Cancer in Japanese Experience: An Assessment from Long Follow-Up Data of Complication and Cancer Control in 806 Patients.

Abstract

Abstract [Introduction] Mastectomy has been conducted in general for cases in which breast conservation is inapplicable. Since Nipple-sparing Mastectomy (NSM) conserves nipple-areola, it is not only more advantageous in an aspect that nipple-areola reconstruction isn't required in case of breast reconstruction compared with mastectomy but also significantly meaningful because the sensation of nipple-areola is preserved in about 70% cases by skin flap preparation based on thick flap method we have adopted. On the other hand, NSM is controversial relating to complication of surgery and recurrence as well. [Objective] We've made (1) review of safety in NSM surgical technique, (2) discussion over recurrence and prognosis comparing with those in mastectomy, and (3) consideration of performance in immediate reconstructions. [Result] (1) Of all cases of NSM, the number of cases in stage 0, 1, 2A, 2B, 3 and 4 was 21, 305, 239, 123, 112 and 6 respectively. During 104 months of follow-up period in average, total of seven complication cases (0.9%) were observed, including two flap necrosis cases and five postoperative bleeding cases, but no nipple necrosis case was recorded. Although nipple-areola recurrence rate (%) in stage 0, 1, 2A, 2B and 3A was 0, 2.9, 4.6, 2.4 and 5.3 respectively, prognosis of nipple-areola recurrence cases was good showing no difference between stages (OS: 60M; 93%, 100M; 84%). Skin flap recurrence rate (%) in stage 0, 1, 2A, 2B and 3 was 0, 3.2, 3.3, 4.0 and 14.2 respectively, and prognosis of skin flap recurrence cases was significantly worse in stage 2B and 3 compared with that in stage 1 and 2A (p < 0.001). (2) We analyzed local recurrence rate, recurrent free survival and overall survival between 806 of NSM cases and 200 of mastectomy cases which had been performed during the same period, and the result showed no significant difference in those rates between NSM and mastectomy cases. (3) Infectious complication was observed in one out of 18 immediate reconstruction cases using free dermal fat graft. Among 124 immediate reconstruction cases using implant, complications were observed in five postoperative bleeding. [Conclusion] NSM was excellent in cosmetic aspect showing equivalent results in local recurrence rate and prognosis compared with those in mastectomy cases. Besides, patient's satisfaction was also higher in those who had had NSM alone without reconstruction. Our long term follow-up data shows that NSM may be considered as an alternative option for mastectomy in cases in which breast-conserving surgery is inapplicable in breast cancer patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-03.