PC40. Evaluating Outcomes for Nipple-Sparing Mastectomy in Patients Over the Age of 60

Abstract

PURPOSE: Nipple-sparing mastectomy (NSM) outcomes in the elderly have not been well characterized. The goal of this study was to evaluate NSM outcomes in patients over age 60. METHODS: A single-institution retrospective review was performed for patients over age 60 with NSM from January 2004 to January 2022. Demographic, intraoperative, and post-operative variables were collected. RESULTS: 136 individuals were identified accounting for 200 mastectomies, with mean age 65.2 years. 56% had invasive carcinoma, 15% required neoadjuvant chemotherapy, and 17.5% had prior radiation. 61.5% had concurrent axillary node surgery. The majority had tissue expanders placed initially (91%). Overall, the infection rate was 19%, with 11.5% requiring expander explantation. In logistic regression analysis, prior radiation increased the odds of any complication 2.9x (OR 2.93, CI 1.30-6.58, p=0.009) and infection 5.7x (OR 5.70, CI 1.95-16.66, p=0.001) but no associations were seen for other covariates including age, comorbidities, chemotherapy, or invasive disease. There were no associations seen for risk of cancer recurrence. Diabetes increased the odds of wound breakdown by 9x (OR 8.97, CI 2.01-39.92, p=0.004). Final reconstruction was implant-based in 70.5% and autologous in 10%. Local recurrence was 3% in mean 3.4 year follow up. CONCLUSION: Our data demonstrates NSM in patients over 60 has acceptable outcomes within the standard of care. Locoregional recurrence was within the cited range of 0-5%, and only diabetes and prior radiation were associated with reconstructive complications. NSM should thus be offered when appropriate regardless of increased age to achieve the desired oncologic and reconstructive outcomes.