Mastectomy For Early-stage Breast Cancer Research Articles

Patient-Reported Outcomes Improve Following Mastectomy for Early-Stage Breast Cancer in Nigeria: Pilot Experience Using a Translated and Validated BREAST-Q

Patient-Reported Outcomes Improve Following Mastectomy for Early-Stage Breast Cancer in Nigeria: Pilot Experience Using a Translated and Validated BREAST-Q

Breast conserving surgery combined with radiation therapy offers improved survival over mastectomy in early-stage breast cancer

IntroductionLandmark trials established equivalent survival regardless of extent of breast surgery in early-stage breast cancer. However, recent studies suggest a survival advantage for breast conserving surgery (BCS) with radiotherapy (BCT). This study assesses the impact of type of surgery on overall survival (OS), breast cancer specific survival (BCSS) and local recurrence (LR) in a modern population-based cohort. MethodsFemale patients aged ≥18, pT1-2pN0, who had surgery between 2006 and 2016 were identified from Breast Cancer Outcome Unit prospective database. Neoadjuvant chemotherapy patients were excluded. Multivariable Cox regression was used to assess the effect of surgical procedure on OS, BCSS, and LR on cohort with complete data. ResultsBCT was performed in 8422 patients and TM in 4034 patients. The baseline characteristics differed between the groups. Mean follow up was 8.3 years. BCT was associated with increased OS HR 1.37, p < 0.001, BCSS survival HR 1.49, p < 0.001, and similar LR HR 1.00, p > 0.90. ConclusionThis study supports that in early-stage breast cancer, BCT has improved BCSS compared to TM without an increased risk of LR.

Distance to radiation therapy facility influences surgery type among older women with early-stage breast cancer.

Breast-conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early-stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. Women diagnosed with stages 0-II breast cancer in 2013-2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio-demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5miles to the nearest RTF, those with distance ≥40 miles or 15-40 miles had higher odds of mastectomy (adjusted (adj) OR=1.39, 95% CI=1.07-1.82; adj OR=1.17, 95% CI=1.02-1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI=1.03-1.51) and 1.19 (95% CI=1.04-1.35), respectively. Age-stratified analysis showed the significant association (p < 0.05) only presented among women aged ≥65, but not those aged <65 years. Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed.

Survival Outcomes of Breast-Conserving Therapy versus Mastectomy in Early-Stage Breast Cancer, Including Centrally Located Breast Cancer: A SEER-Based Study.

Purpose This study aims to analyze the survival outcomes of breast cancer (BC) patients, especially centrally located breast cancer (CLBC) patients undergoing breast-conserving therapy (BCT) or mastectomy. Methods Surveillance, epidemiology, and end results (SEER) data of patients with T1-T2 invasive ductal or lobular breast cancer receiving BCT or mastectomy were reviewed. We used X-tile software to convert continuous variables to categorical variables. Chi-square tests were utilized to compare baseline information. The multivariate logistic regression model was performed to evaluate the relationship between predictive variables and treatment choice. Survival outcomes were visualized by Kaplan–Meier curves and cumulative incidence function curves and compared using multivariate analyses, including the Cox proportional hazards model and competing risks model. Propensity score matching was performed to alleviate the effects of baseline differences on survival outcomes. Result A total of 180,495 patients were enrolled in this study. The breast preservation rates fluctuated around 60% from 2000 to 2015. Clinical features including invasive ductal carcinoma (IDC), lower histologic grade, smaller tumor size, fewer lymph node metastases, positive ER and PR status, and chemotherapy use were independently correlated with BCT in both BC and CLBC cohorts. In all the classic Cox models and competing risks models, BCT was an independent favorable prognostic factor for BC, including CLBC patients in most subgroups. In addition, despite the low breast-conserving rate compared with tumors located in the other areas, CLBC did not impair the prognosis of BCT patients. Conclusion BCT is optional and preferable for most early-stage BC, including CLBC patients.

Breast-conserving therapy is associated with better survival than mastectomy in Early-stage breast cancer: A propensity score analysis.

BackgroundRecent retrospective studies have reported that breast‐conserving therapy (BCT) led to improved overall survival (OS) than mastectomy in some populations. We aimed to compare the efficacy of BCT and mastectomy using the SEER database.Materials and methodsBetween 2010 and 2015, 99,790 eligible patients were identified. We included early‐stage breast cancer patients with 5cm or smaller tumors and three or fewer positive lymph nodes in our study. We compared the OS and breast cancer‐specific survival (BCSS) results among patients with BCT and those with mastectomy. Kaplan‐Meier plots, Cox proportional hazard regressions, competing risk analysis, and multivariate regressions were used to evaluate the outcomes. Propensity‐score matching was used to assemble a cohort of patients with similar baseline characteristics.ResultsIn our study, 77,452 (77.6%) patients underwent BCT and 22,338 (22.4%) underwent mastectomy. The 5‐year OS rate was 94.7% in the BCT group and 87.6% in the mastectomy group, and the 5‐year BCSS was 97.2% in the BCT and 94.3% in the mastectomy group. Multivariate analysis in the matched cohort showed that women underwent mastectomy was associated with worse OS (Hazard ratio (HR) = 1.79; 95% confidence intervals (CIs) = 1.59–2.02, p < 0.001) and BCSS (HR = 1.88; 95% CIs = 1.61–2.18, p < 0.001) results compared with those underwent BCT. Patients with different subtypes and age group (>50 years old; ≤50 years old) received BCT showed significantly better OS and BCSS results than those received mastectomy. The effect of surgery choice on survival yielded similar results either for all patients or matched cohorts.ConclusionsOur study showed that BCT was associated with improved survival compared with mastectomy in early‐stage breast cancer patients. It seems advisable to encourage patients to receive BCT rather than mastectomy in early‐stage patients when feasible and appropriate.

PP35 Presentation Time: 11:30 AM: An Organ at Risk Dosimetric Comparison of HDR Multicatheter Brachytherapy versus External Beam Intensity Modulated Accelerated Partial Breast Irradiation

Purpose: Accelerated partial breast irradiation (APBI) is an adjuvant treatment option for select patients following partial mastectomy for early-stage breast cancer. Multiple APBI techniques have been described for both external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. Given the differences in these treatment techniques, we aimed to compare radiation dose to adjacent organs at risk (OARs) between 8 fraction HDR multicatheter interstitial brachytherapy and 5 fraction external beam intensity modulated radiation therapy (IMRT).

Choice of local therapy for young women with early-stage breast cancer who have young-aged children.

Decision making regarding the initial treatment of women with breast cancer is complicated. In the current study, the authors examined the relationship between treatment choices and their children's ages among young women with early-stage breast cancer. Using the MarketScan Commercial Claims and Encounters database, the authors identified women aged 20 to 50 years who underwent lumpectomy or mastectomy for early-stage breast cancer between 2008 and 2014. Predictors of compliance with radiotherapy after undergoing lumpectomy and of undergoing mastectomy were determined using multinomial logistic regression. The authors conducted sensitivity analyses to explore the impact of the number of young-aged children and a reduction in the sample size in 2014 due to the attrition of health plans contributing to MarketScan. A total of 21,052 women were included in the current analysis. Among women with at least 1 child aged <7 years, the adjusted rate of lumpectomy was 59.9%; approximately 22% of these women did not receive radiotherapy. Compared with women undergoing lumpectomy plus radiotherapy, women with at least 1 child aged <7 years or aged 7 to 12 years were 25% and 16%, respectively, more likely to undergo lumpectomy alone compared with women with no children aged <18 years (P=.002 and P=.012, respectively) and 64% and 37%, respectively, more likely to undergo mastectomy (P<.001). Among privately insured women with breast cancer, having young children was found to be strongly associated with the omission of postlumpectomy radiotherapy or undergoing mastectomy. Having >1 young-aged child further amplified these associations. The findings of the current study suggested that caring for young children may present unique challenges to young women with breast cancer.

Breast-Conserving Therapy is Associated with Improved Survival Compared with Mastectomy for Early-Stage Breast Cancer: A Propensity Score Matched Comparison Using the National Cancer Database.

Current recommendations for early-stage breast cancer are largely based on the NSABP B-06 trial demonstrating equivalent survival between mastectomy and lumpectomy. We sought to compare breast-conserving therapy (BCT) with mastectomy for treatment of early-stage breast cancer in a contemporary patient population. A query of the NCDB PUF identified female breast cancer patients diagnosed from 2004 to 2015. Patients with stage I or II disease were included. BCT was defined as the receipt of lumpectomy plus radiation. Propensity scores were tabulated using race, age, Charlson/Deyo score, tumor site, laterality, histology, grade, size, number of nodes positive, lymph-vascular invasion, receptor status, receipt of chemotherapy, and endocrine therapy. Patients who received BCT versus mastectomy were matched using a 1:1 nearest neighbor technique. The primary outcome measured was overall survival. After exclusions and matching, two equal groups of 101,118 patients remained. Median follow-up was 42months. The majority had invasive ductal histology (77%), and node-negative disease (84%). Receptor status included ER-positive (83%), PR-positive (73%), and HER2/Neu-positive (15%). Chemotherapy was received in 38% and endocrine therapy in 71%. Propensity score matching yielded equivalent groups across all target variables. The 5-year overall survival was superior for BCT compared with mastectomy (92.9% vs. 89.7%, p < 0.001; Fig.1). This survival advantage persisted for both stage I (p < 0.001) and stage II (p < 0.001) disease on subgroup analysis. Fig.1 Overall survival in female patients with early stage invasive breast cancer (stage I or II) undergoing breast conservation surgery with radiation compared with mastectomy. BCS breast conservation surgery CONCLUSIONS: BCT is associated with superior overall survival compared with mastectomy for early-stage breast cancer using well-matched, contemporary data.

Understanding Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early-Stage Breast Cancer.

Objective:To identify factors that influence Saskatchewan women’s choice between breast conserving therapy (BCT) and mastectomy in early-stage breast cancer (ESBC) and to compare and contrast underlying reasons behind choice of BCT versus mastectomy.Methods:Interpretive description methods guided this practice-based qualitative study. Data were analyzed using thematic analysis and presented in thematic maps.Results:Women who chose mastectomy described 1 of the 3 main themes: worry about cancer recurrence, perceived consequences of BCT treatment, or breast-tumor size perception. In contrast, women chose BCT because of 3 different themes: mastectomy being too radical, surgeon influence, and feminine identity.Conclusions:Although individual reasons for choosing mastectomy versus BCT have been discussed in the literature before, different rationale underlying each choice has not been previously described. These results are novel in identifying interdependent subthemes and secondary reasons for each choice. This is important for increased understanding of factors influencing a complicated decision-making process.

Abstract P2-12-09: Long-term follow-up of nipple-sparing mastectomy for early-stage breast cancer without radiotherapy: A single-center study at a Japanese institution

Abstract Introduction: Achievement of a good cosmetic outcome is one of the most important goals of surgical treatment of breast cancer. However, most patients must undergo a mastectomy if the outcome of breast-conserving surgery is discordant. All potential techniques that maintain oncological safety should be considered to maximize the cosmetic outcome for patients who require a mastectomy. We began performing nipple-sparing mastectomy (NSM) in 1978. Recent reports have suggested that NSM is oncologically as safe as mastectomy and affords a better cosmetic outcome. Conversely, the surgical complications and recurrence associated with NSM remain controversial. Objective: In the present study, we review the safety of the NSM surgical technique, discuss nipple–areola recurrence and skin flap recurrence after NSM, and compare recurrence and prognosis between NSM and mastectomy based on our long-term follow-up data. Patients and Methods: We retrospectively analyzed 723 patients with early-stage breast cancer who underwent NSM from 1985 to 2007. The patients' median age, tumor size, and tumor–areola distance were 50 y, 2.1 cm, and 1.5 cm, respectively. We used a thick skin flap method to avoid surgical complications including nipple and skin flap necrosis. We analyzed nipple–areola recurrence and skin flap recurrence after NSM. We also analyzed 100 patients who underwent mastectomy for early-stage breast cancer during the same period as those who underwent NSM. We compared the local recurrence rate (LRR), disease-free survival (DFS) rate, and overall survival (OS) rate among all 723 patients who underwent NSM and 100 patients who underwent mastectomy. No patients in either group received radiotherapy. Results: Among all patients who underwent NSM, stage 0, 1, 2A, and 2B disease was present in 21, 320, 253, and 129 patients, respectively. Notably, no nipple necrosis occurred during the average 114-month follow-up period. Local recurrence developed in 49 patients (6.7%), including recurrence at the nipple–areola complex in 24 (3.3%) and recurrence at the skin flap in 25 (3.4%). The average disease-free interval in patients with nipple–areola recurrence was 50 months, and that in patients with skin flap recurrence was 68 months. The clinical features of nipple–areola recurrence were a low rate of ER positivity (27%), high rate of Her2/neu positivity (60%), Paget type recurrence rate of 52%, and small tumor–areola distance (0.5 cm). The clinical features of skin flap recurrence were a relatively high rate of ER positivity (55%), solitary type recurrence rate of 88%, and diffuse type recurrence rate of 12%. The prognosis of diffuse type skin flap recurrence was significantly worse than that of solitary type recurrence (p = 0.01). There were no significant differences between the NSM and mastectomy groups in the LLR (6.7% vs. 4.0%, respectively), 10-y DFS rate (88% vs. 90%, respectively), or 10-y OS rate (92% vs. 91%, respectively). Conclusion: Our long-term follow-up data show that NSM should be considered as an alternative option for mastectomy when the outcome of breast-conserving surgery is discordant in patients with early-stage breast cancer. Citation Format: Sakurai T, Suzuma T, Yoshimura G, Jinta E, Umemura T, Sakurai T. Long-term follow-up of nipple-sparing mastectomy for early-stage breast cancer without radiotherapy: A single-center study at a Japanese institution. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-09.

Misperceptions Lead to Increase in Mastectomy for Early-Stage Breast Cancer

Misperceptions Lead to Increase in Mastectomy for Early-Stage Breast Cancer

Nationwide trends in mastectomy for early-stage breast cancer.

Accredited breast centers in the United States are measured on performance of breast conservation surgery (BCS) in the majority of women with early-stage breast cancer. Prior research in regional and limited national cohorts suggests a recent shift toward increasing performance of mastectomy in patients eligible for BCS. To examine whether mastectomy rates in patients eligible for BCS are increasing over time nationwide, and are associated with coincident increases in breast reconstruction and bilateral mastectomy for unilateral disease. We performed a retrospective cohort study of temporal trends in performance of mastectomy for early-stage breast cancer using multivariable logistic regression modeling to adjust for pertinent covariates and interactions. We studied more than 1.2 million adult women treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer from January 1, 1998, to December 31, 2011, using the National Cancer Data Base. Year of breast cancer diagnosis. Proportion of women with early-stage breast cancer who underwent mastectomy. Secondary outcome measures include temporal trends in breast reconstruction and bilateral mastectomy for unilateral disease. A total of 35.5% of the study cohort underwent mastectomy. The adjusted odds of mastectomy in BCS-eligible women increased 34% during the most recent 8 years of the cohort, with an odds ratio of 1.34 (95% CI, 1.31-1.38) in 2011 relative to 2003. Rates of increase were greatest in women with clinically node-negative disease (odds ratio, 1.38; 95% CI, 1.34-1.41) and in situ disease (odds ratio, 2.05; 95% CI, 1.95-2.15). In women undergoing mastectomy, rates of breast reconstruction increased from 11.6% in 1998 to 36.4% in 2011 (P < .001 for trend). Rates of bilateral mastectomy for unilateral disease increased from 1.9% in 1998 to 11.2% in 2011 (P < .001). In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. Mastectomy rates do not yet exceed current American Cancer Society/American College of Surgeons Commission on Cancer accreditation benchmarks. Further research is needed to understand factors associated with these trends and their implications for performance measurement in American Cancer Society/American College of Surgeons Commission on Cancer centers.

Skin involvement in diffuse large B‐cell lymphoma detected using positron emission tomography

A 76-year-old Japanese woman presented with lymphadenopathy of the right neck and precordial erythematous thickening of the skin (Fig 1). She had undergone a left mastectomy for early-stage breast cancer 20 years before. She did not receive chemotherapy or radiotherapy at that time and no recurrence had occurred to date. An operative scar was detected on her right chest wall, but she had never experienced lymphedema after the mastectomy. Three months before her referral, she had noticed a pea sized lymph node on her right neck. Because of the enlargement of systemic lymph nodes followed by the development of a precordial skin lesion, she visited the hospital. The cervical lymph node biopsy specimen revealed diffuse proliferation of large abnormal lymphocytes with frequent mitotic figures. The following immunostaining pattern was observed: CD3, negative; CD20, positive; CD79a, positive; and Ki-67, positive (about 70–80% of tumor cells). Accordingly, she was diagnosed with diffuse large B-cell lymphoma (DLBCL). Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) indicated a high FDG uptake in the skin lesion, as well as in the cervical lymph nodes (Fig 2). (a) Enlarged right cervical and supraclavicular lymph nodes. (b) Precordial erythematous thickening of the skin. (a) Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed skin involvement (white arrowhead) and mediastinal lymph node swelling as indicated by a high FDG uptake. (b) The high FDG uptake on PET (red arrowhead) appeared to correspond well with the skin lesions in Figure 1b. Several reports have described variability in FDG avidities of histologic lymphoma subtypes.1, 2 To accurately delineate the extent of the disease, FDG-PET is now routinely recommended for the staging of patients with FDG-avid lymphomas, such as DLBCL and Hodgkin's disease.3 Although the relationship between skin involvement in DLBCL and findings from FDG-PET has rarely been reported,2 we speculate that a high FDG uptake on PET corresponds with the skin involvement in DLBCL, as well as in the case of primary cutaneous DLBCL. A skin lesion might be related to a history of breast cancer; however, the patient had never experienced lymphedema after the mastectomy and the precordial lesion developed after systemic lymph node swelling. Thus, skin involvement of DLBCL had no relationship with the previous treatment for breast cancer. We thank Dr Yasumasa Monobe, Department of Pathology, Kawasaki Medical School Kawasaki Hospital, for helpful comments and discussion during drafting of this report. The authors also would like to thank Enago (http://www.enago.jp; Mumbai, India) for the English language review. No authors report any conflict of interest.

Can nipple-sparing mastectomy serve as an alternative to mastectomy for early-stage breast cancer without radiotherapy? Over 20-year experience at a Japanese institution.

e12030 Background: A cosmetic outcome is one of the most important goals of surgical treatment of breast cancer. We began performing nipple-sparing mastectomy (NSM) in 1978. NSM is a controversial ...

Breast Conserving Surgery versus Mastectomy for Early-Stage Breast Cancer: Could Patient Choice Lead to an Inferior Outcome?

Breast Conserving Surgery versus Mastectomy for Early-Stage Breast Cancer: Could Patient Choice Lead to an Inferior Outcome?

Increasing Use of Elective Mastectomy and Contralateral Prophylactic Surgery Among Breast Conservation Candidates

First-line surgical options for early-stage breast cancer include breast-conserving surgery (BCS) or mastectomy. We analyzed factors that influence the receipt of mastectomy and resultant trends over time. We analyzed the rates of mastectomy and BCS for 1634 women who underwent upfront surgical treatment for AJCC stage 0, I, or II breast cancer between 1995 and 2008 using data from the University of Louisville James Graham Brown Cancer Center Tumor Registry. We examined the trend of treatment over time and assessed the probability of receiving mastectomy using multivariate logistic regression. Overall, 65.9% of women received BCS, and 34.1% received mastectomy over a 14-year period (annual BCS rate range, 38.6% to 77.7%). The mastectomy rate substantially decreased from 43.5% in 1995 to 22.5% in 2004 (P = 0.0007) but then increased to 51.7% in 2008 (P < 0.0001). During the years between 2004 and 2008 (vs. 1995 to 2003), there was a significant increase in the rates of mastectomy performed in conjunction with immediate reconstruction (IR: 35.7% vs. 8.4%; P < 0.0001) and/or contralateral prophylactic mastectomy (CPM: 22.9% vs. 3.3%; P < 0.0001). On the basis of the multivariate analysis, the rate of receiving mastectomy was drastically higher for patients treated since 2004 (vs. before 2004), uninsured and government-insured (vs. privately insured) patients, patients with pT2 disease (vs. pTis or pT1), patients with pN1 disease (vs. pNX or pN0). In this longitudinal registry study, major independent determinants of mastectomy for early-stage breast cancer include year of diagnosis, insurance status, and stage. Mastectomy rates declined until 2004, but have since increased in conjunction with immediate reconstruction and contralateral prophylactic mastectomy. Additional study is needed to identify the underlying reasons for and unintended consequences of the reemergence of radical surgery for early-stage breast cancer in the era of multidisciplinary care.

The Role of Margin Status and Reexcision in Local Recurrence Following Breast Conservation Surgery

Breast conservation surgery (BCS) results in survival equal to mastectomy for early-stage breast cancer. Ipsilateral breast tumor recurrence (IBTR) after BCS is thought to be related to margin status. At our institution, reexcision is performed only if tumor is at inked margin or with extensive disease close to multiple margins. The purpose of this study was to determine rates of reexcision and recurrences among BCS patients using this policy. We performed an institutional review board-approved retrospective analysis of BCS patients who underwent surgery between January 2001 and June 2005. We identified patients who had a second breast excision within 8 weeks of the first, and those patients with an IBTR. Clinical and pathologic features of patients' tumors were reviewed. We identified 543 patients who underwent BCS, 84 patients (15.5 %) underwent reexcision for margin status. The crude IBTR rate was 3.4 %, and the 5-year local recurrence-free survival of the reexcised group was 90.6 % compared with 97.4 % in the non-reexcised group (p = 0.0097). Of the 64 reexcision patients, 6 (9.4 %) had an IBTR versus 12 (2.6 %) of the 459 non-reexcised patients (p = 0.0151). Our reexcision rate is low compared with other reports. This results from a policy that defines "no tumor on ink" as an adequate margin for BCS, and the use of selective irradiation boosts based on margins assessed by our pathologists. Our local recurrence rate compares favorably with those seen in other studies while minimizing the need for additional operations. A higher IBTR rate after reexcision likely reflects tumor biology.

Prospective Evaluation of the Nipple–Areola Complex Sparing Mastectomy for Risk Reduction and for Early-Stage Breast Cancer

Psychological effects of mastectomy for women with breast cancer have driven treatments that optimize cosmesis while strictly adhering to oncologic principles. Although skin-sparing mastectomy is oncologically safe, questions remain regarding the use of nipple-areola complex (NAC)-sparing mastectomy (NSM). We prospectively evaluated NSM for patients undergoing mastectomy for early-stage breast cancer or risk reduction. We enrolled 33 early-stage breast cancer and high-risk patient; 54 NSMs were performed. NAC viability and surgical complications were evaluated. Intraoperative and postoperative pathologic assessments of the NAC base tissue were performed. NAC sensory, cosmetic and quality of life (QOL) outcomes were also assessed. Twenty-one bilateral and 12 unilateral NSMs were performed in 33 patients, 37 (68.5%) for prophylaxis and 17 (31.5%) for malignancy. Mean age was 45.4years. Complications occurred in 16 NACs (29.6%) and 6 skin flaps (11.1%). Operative intervention for necrosis resulted in 4 NAC removals (7.4%). Two (11.8%) of the 17 breasts with cancer had ductal carcinoma-in-situ at the NAC margin, necessitating removal at mastectomy. All evaluable patients had nipple erection at 6 and 12months postoperatively. Cosmetic outcome, evaluated by two plastic surgeons, was acceptable in 73.0% of breasts and 55.8% of NACs, but lateral displacement occurred in most cases. QOL assessment indicated patient satisfaction. NSM is technically feasible in select patients, with a low risk for NAC removal resulting from necrosis or intraoperative detection of cancer, and preserves sensation and QOL. Thorough pathologic assessment of the NAC base is critical to ensure disease eradication.

Surgical Margins and the Risk of Local-Regional Recurrence (LRR) following Mastectomy for Early-stage Breast Cancer

Surgical Margins and the Risk of Local-Regional Recurrence (LRR) following Mastectomy for Early-stage Breast Cancer

Lack of Radiation-induced Pulmonary Toxicity 25 years after Treatment with Breast Conservation Therapy or Mastectomy for Early-stage Breast Cancer: Results from the NCI Randomized Trial

Lack of Radiation-induced Pulmonary Toxicity 25 years after Treatment with Breast Conservation Therapy or Mastectomy for Early-stage Breast Cancer: Results from the NCI Randomized Trial