Abstract
Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. The patients were followed up for a mean time of 132 months since the first surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy.
Highlights
Several factors are related to a higher risk of developing ipsilateral breast tumor recurrence (IBTR), such as high tumor grade, positive excision margins, and younger age.[1,2] Tumor recurrence can be associated to the aggressiveness and progression of the disease
After the nipple-sparing mastectomy (NSM), 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died
We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy
Summary
Several factors are related to a higher risk of developing ipsilateral breast tumor recurrence (IBTR), such as high tumor grade, positive excision margins, and younger age.[1,2] Tumor recurrence can be associated to the aggressiveness and progression of the disease. Nipple-sparing mastectomy (NSM) is a conservative mastectomy approach for early breast cancer, with oncological safety and good aesthetic satisfaction.[6,7] The initial indications for NSM excluded patients with previous radiation, ptosis, high body mass index (BMI), and macromastia, these contraindications have been challenged. Different authors have expanded the classic indications for NSM for patients with previous breast surgery/irradiation, neoadjuvant chemotherapy, and short tumor-nipple distance, and showed safety and low complication rates associated.[8,9,10,11] there are few data about the suitability of performing NSM with immediate reconstruction for the treatment of recurrent disease.[12,13] High complication rates were evidenced in patients with a history of previous BCS followed by radiation.[14,15,16] the quality of the skin and previous adjuvant radiotherapy (RT) should be considered for reconstruction in this setting
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