Skin-sparing Mastectomy Group Research Articles

Immediate Prepectoral Tissue Expander Breast Reconstruction Without Acellular Dermal Matrix Is Equally Safe Following Skin-Sparing and Nipple-Sparing Mastectomy.

Prepectoral breast reconstruction has become increasingly popular over the last decade. There is a paucity of data surrounding the impact of mastectomy type on clinical outcomes when comparing prepectoral immediate breast reconstruction without acellular dermal matrix (ADM) using tissue expansion. The purpose of this study was to compare 90-day reconstructive surgical outcomes in immediate prepectoral tissue expander reconstruction between patients with nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM). A retrospective review of patient records was carried out on all patients undergoing NSM or SSM with immediate prepectoral tissue expander reconstruction without ADM, in a single institution, from June 2020 to December 2021. All complications were recorded, categorized, and statistically analyzed for significance. Seventy-nine patients (97 breasts) were studied. The mean age was 51 years old (range, 31-77). Twenty-two patients suffered complications recorded in 22 breasts (22.7%). There was no statistically significant difference in the total complications between the NSM (25.7%) and SSM (21.0%) groups or in the incidence of all major and minor complications. Breast reconstruction using tissue expanders without ADM has similar reconstructive outcomes in both NSM and SSM. There were no significant differences in complication rates between either groups. Breast reconstruction without ADM can confer institutional cost savings without compromising safety.

Bilateral Implant-based Breast Reconstruction with Unilateral Radiotherapy: A Matched Cohort Study Comparing Nipple-sparing Mastectomy and Skin-sparing Mastectomy.

Nipple-sparing mastectomy (NSM) preserves the natural nipple-areola complex and entire native breast skin, with the goal of better cosmetic outcomes in breast reconstruction. In bilateral TE/implant-based reconstruction requiring unilateral postmastectomy radiotherapy (PMRT), progressive radiation-induced fibrosis can lead to increasing nipple asymmetry with cosmetic dissatisfaction. Thus, PMRT may ultimately negate the intended positive cosmetic value of NSM compared with skin-sparing mastectomy (SSM). This study compares (1) surgical complications, (2) patient satisfaction, and (3) aesthetic outcomes between NSM versus SSM in bilateral implant-based reconstruction with unilateral PMRT. This retrospective matched cohort study included consecutive NSM patients with bilateral TE/implant breast reconstruction + unilateral PMRT matched 1:2 to SSM group. Patients completed PMRT and TE exchange to implants. Demographics, oncologic stage, comorbidities, and complications were collected. Patient satisfaction was evaluated by BREAST-Q. Aesthetic outcomes were assessed by blinded reviewers with a five-point Likert scale. Among 58 patients who underwent bilateral TE/implant reconstruction with unilateral PMRT, 17 NSM patients were matched to 41 SSM patients by age, body mass index, and comorbidities. No significant differences existed in overall surgical complications and individual BREAST-Q questionnaire scores between cohorts. However, aesthetic outcomes scores were higher in SSM compared with NSM. Although NSM is generally associated with superior cosmetic outcomes compared with SSM, it has far less impact in bilateral implant-based breast reconstruction with unilateral PMRT due to the negative postradiotherapy effect on nipple symmetry.

The comparison of effectivity in breast cancer prevention between skin sparing and subcutaneous mastectomy - 20 years of experience.

Breast cancer is the leading cause of neoplasm mortality among women. Several prevention strategies have been implemented to early detect and prevent the cancer occurrence. The most effective protocol includes prevention mastectomy for the high-risk patients. In our study, we have compared the efficacy of subcutaneous mastectomy (SCM) and skin sparing mastectomy (SSM) in long-term follow up. We have included 201 female patients who have been treated at our department over the course of 20 years between 2000 and 2019. All the patients were at high risk of developing breast cancer and therefore were indicated for the prophylactic mastectomy. The main indication was the presence of the mutation in the BRCA1 or BRCA2 cluster, however, even in the lack of such mutation, the family history was sufficient for the mastectomy indication. Patients underwent either SCM, SSM or areola sparing mastectomy (ASM), and were allocated to aforementioned groups, respectively. We have collected the data regarding the reconstruction method along with age, weight, height, body mass index (BMI) and presence of predisposing genetic mutations such as BRCA positivity. The patients who underwent SSM compared to those who underwent SCM were of higher age, with higher BMI and body mass. The patients in SSM group had statistically significantly higher BMI than in ASM. There was no difference in efficacy between patients who underwent SSM and SCM. The majority of patients (91.5%) were positive for BRCA1 or BRCA2 mutation. In our study, only four patients were tested negative for known breast cancer inducing mutation (three in SCM and one in SSM). The most common reconstruction method was an abdominal flap and breast implant. Prophylactic mastectomy is a reliable strategy for significantly reducing the number of breast cancer incidence in high-risk patients regardless of the selected method of mastectomy. These operations allow for the subsequent reconstruction with the whole spectrum of reconstructive options.

Long-term follow-up of complex oncoplastic breast-conserving surgery, standard breast conservation and skin-sparing mastectomy in DCIS - a register-based study

BackgroundFew studies evaluate oncological safety in complex oncoplastic breast-conserving surgery(C-OBCS) for DCIS. It still needs to be defined whether it is equivalent to standard breast conservation(S-BCS) or an alternative to skin-sparing mastectomy(SSM). This study compares local recurrence rates(LR), disease-free survival(DFS) and overall survival (OS) between the three surgical techniques. MethodsWe conducted a retrospective register-based study on LR, DFS and OS of patients operated with S-BCS(n=1388), C-OBCS (n=106) or skin-sparing mastectomy (n=218) for DCIS diagnosed 2007–2020. Data was extracted from the Norwegian Breast Cancer Registry. ResultsIn the S-BCS, C-OBCS and SSM groups, median age was 60, 58 and 51 years (p<0.001), median size 15, 25, and 40 mm (p<0.001) and median follow-up 55, 48 and 76 months. At ten years, the overall LR was 12.7%, 14.3% for S-BCS, 11.2% for C-OBCS and 6.8% for SSM. Overall DFS at ten years was 82.3%, 80.5% for S-BCS, 82.4% for C-OBCS and 90.4% for SSM. At ten years, the OS was 93.8%, 93.0% in S-BCS, 93.3% in C-OBCS and 96.6% in the SSM group. Weighted Kaplan Meier plots showed that SSM had a significantly higher DFS than S-BCS (p=0.003) and C-OBCS (p=0.029). DFS in C-OBCS versus S-BCS and the difference in OS was not significant (p=0.264). ConclusionSSM had a significantly higher DFS than S-BCS and C-OBCS. The difference in DFS between S-BCS and C-OBCS, and OS between the three groups was not statistically significant. Our study suggests that C-OBCS is a safe alternative to S-BCS and SSM.

D134. Comparison of Nipple-sparing Mastectomy versus Skin-sparing Mastectomy in Bilateral Implant-based Breast Reconstruction with Unilateral Radiotherapy: A Matched Cohort Study

PURPOSE: Nipple-sparing mastectomy (NSM) preserves natural nipple-areola complex and entire native breast skin with a goal of better cosmetic outcomes in breast reconstruction. In bilateral tissue expander (TE)/implant-based reconstruction requiring unilateral post-mastectomy radiotherapy (PMRT), progressive radiation-induced fibrosis can lead to increasing nipple asymmetry with cosmetic dissatisfaction. Thus, PMRT may ultimately negate the intended positive cosmetic value of NSM compared to skin-sparing mastectomy (SSM). This study compares, 1) surgical complications, 2) patient satisfaction, and 3) aesthetic outcomes between NSM vs. SSM in bilateral implant-based reconstruction with unilateral PMRT. METHOD: This retrospective matched cohort study included consecutive NSM patients with TE/implant breast reconstruction + unilateral PMRT matched 1:2 to SSM group. All patients completed PMRT and TE exchange to implants. Demographics, oncologic stage, co-morbidities, and complication data were collected. Patient satisfaction was evaluated by BREAST-Q. Aesthetic outcome was assessed by blinded reviewers with a 5-point Likert scale. RESULTS: Among 58 patients who underwent bilateral TE/implant reconstruction with unilateral PMRT, 17 NSM patients were matched to 41 SSM patients by age, BMI, and co-morbidities. No significant difference existed between overall surgical complications (p=0.2) and BREAST-Q questionnaire scores. The average adverse effects of radiation score was higher in the NSM. Preliminary aesthetic outcomes demonstrated higher total average aesthetic score in SSM compared to NSM. CONCLUSION: Although NSM is generally associated with better cosmetic outcome compared to SSM, it has far less impact in bilateral implant-based breast reconstruction with unilateral PMRT. This may be related to the additional negative post-radiotherapy impact on nipple asymmetry.

Abstract P2-14-18: Oncological Outcomes of Nipple-Sparing Mastectomy after Neoadjuvant Chemotherapy

Abstract Introduction: Surgery is the mainstay treatment of breast cancer and has been improving in aesthetic outcomes even in locally advanced disease. Radical mastectomies are being replaced by less aggressive surgeries with immediate breast reconstruction. Nipple-Sparing Mastectomy (NSM) preserves Nipple Areolar Complex (NAC) along with the entire breast skin envelope and is associated with better aesthetic results and quality of life, improving patient satisfaction. Since NSM is a relatively recent technique and few studies have shown the feasibility of NSM after neoadjuvant chemotherapy (NACT), there are some concerns and controversies about its oncological safety, especially, with regard to the NAC recurrence due to the remaining tissue in the retroareolar area. This study compares the long-term oncological outcomes and correlated factors of NSM and skin-sparing mastectomy (SSM) after NACT. Methods: After approval by the institution’s ethics committee a retrospective review was conducted to identify all patients who underwent NSM and SSM with immediate breast reconstruction after NACT between January 2011 and December 2018 at Centro de Doenças da Mama- Breast Unit Hospital Nossa Senhora das Graças. Metastatic disease, recurrent breast cancer, and other types of mastectomies were excluded. Clinicopathological and survival data, as well as recurrence events were collected from the electronic medical records. NSM was offered to the patients without involvement of the NAC and skin clinically and on imaging. All patients underwent ultrasonography, mammography and breast MRI in the preoperative period, as well as breast MRI after NACT. The decision to undergo adjuvant radiotherapy was determined by the treating radiation oncologists according to NCCN and ASTRO recommendation. A propensity score match was used to reduce the effect of selection bias on type of surgery and create well-balanced groups. The covariates included for matching were: anatomical stage, radiotherapy and molecular subtype. Results: A total of 188 patients underwent mastectomy in this period, 134 NSM and 54 SSM. After propensity score matching, 92 patients in the NSM group were matched to the 54 patients in the SSM group. The median follow up time was 44,7 months to NSM and 40,3 months to NSM. The characteristics of patients included in both groups after propensity score matching are described in Table 1. NAC recurrence was observed in 5 (5.4%) of 92 NSM patients, and median time of recurrence was 24.2 (11.7- 40.1) months. Ki67 showed a significant relationship with relapse in the NAC. The distance from the tumor to the NAC and other clinicopathologic variables were not correlated with NAC recurrence (Table 2). There were no significative differences between the groups in locorregional recurrence (p=0.102), distant metastasis (p=0.223) and death (p=0.610) (Table 3). Conclusion: In this matched control study, there was no difference in oncological outcomes in patients submitted to NSM and SSM after NACT, suggesting NSM with immediate breast reconstruction is a feasible option in this setting. Table 1. Characteristics of patients treated with NSM and SSM after propensity score matching *Student’s t test for independent samples or non-parametric Mann-Whitney test (quantitative variables); Fisher’s exact test or chi square test (categorical variables); p&amp;lt;0.05 Table 2. Correlation between clinicopathologic variables and recurrence in the NAC *Fine and Gray Regression Model including death as a competitive risk and Wald test, p&amp;lt;0.05 Table 3. Oncological outcomes in NSM and SSM groups *Model Fine &amp; Gray and Wald test, p&amp;lt;0,05 **Cox Regression Model and Wald test, p&amp;lt;0.05 *** Log-rank test, p&amp;lt;0,05 Citation Format: IRIS RABINOVICH, Leonardo P. Nissen, Isabela C. Soares, Alessandra C. Fornazari, Cleverton C. Spautz, Ana Paula M. Sebastião, CICERO A. URBAN, Karina F. Anselmi, Eduardo Schunemann, Flavia Kuroda, Maira T. Doria, Ana Clea S. Andrade, Rubens S. Lima. Oncological Outcomes of Nipple-Sparing Mastectomy after Neoadjuvant Chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-18.

Satisfaction with Long-Term Aesthetic and 10 Years Oncologic Outcome following Risk-Reducing Mastectomy and Implant-Based Breast Reconstruction with or without Nipple Preservation.

Simple SummaryWomen at significant increased risk of developing breast cancer may choose to undergo removal of both breasts (mastectomy) with reconstruction of the breasts using silicone implants. This study aimed to compare satisfaction, aesthetic and cancer related outcomes in women undergoing bilateral mastectomy comparing those who had the nipples removed and then a nipple reconstruction with women who had surgery with preservation of the nipples. Ninety-three women participated, sixty (64.5%) had nipple preservation and thirty-three (35.5%) nipples removed. Nipple projection was shorter in the reconstructed nipple group than the preserved nipple group. There was no significant difference in overall symmetry, satisfaction regarding nipple preservation or overall nipple satisfaction. There were no diagnoses of breast cancer in the study population who were followed up for approximately 10 years. We concluded that women who undergo nipple preserving surgery maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction.Incidence of bilateral risk-reducing mastectomies (RRMs) is increasing. The aim of this study was to compare satisfaction, aesthetic and oncological outcomes in women undergoing RRM with implant-based reconstruction comparing nipple-sparing mastectomy (NSM) with skin-sparing mastectomy (SSM) (sacrificing the nipple +/− nipple reconstruction). Women who had undergone bilateral RRM between 1997 and 2016 were invited. Aesthetic outcome and nipple symmetry were evaluated using standardized anthropometric measurements. The oncological outcome was assessed at last documented follow up. Ninety-three women (186 breasts) participated, 60 (64.5%) had NSM, 33 (35.5%) SSM. Median time between surgery and participation was 98.4 months (IQR: 61.7–133.9). Of the women, 23/33 (69.7%) who had SSM underwent nipple reconstruction. Nipple projection was shorter in the reconstructed SSM group than the maintained NSM group (p < 0.001). There was no significant difference in overall symmetry (p = 0.670), satisfaction regarding nipple preservation (p = 0.257) or overall nipple satisfaction (p = 0.074). There were no diagnoses of breast cancer at a median follow up of 129 months (IQR: 65–160.6). Women who undergo nipple-sparing RRM maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction. Although satisfaction with the nipples was higher in the NSM group, this did not reach statistical significance. No breast cancers developed after RRM with long-term follow up.

Sensory Reinnervation With Subcutaneously Embedded Innervated Flaps: An Experimental Study in Rats.

In breast reconstruction, both aesthetic outcomes and sensory function are important for postoperative quality of life. Innervated flaps are useful in reconstruction after conventional mastectomy (CM), which leaves a large portion of the skin paddle exposed on the body surface. However, whether they are also useful in skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) remains unclear. This study aimed to examine the usefulness of innervated flaps in restoring sensation after SSM and NSM using a rat model. Dorsal cutaneous nerves of rats were entirely eliminated except for the medial branch of the dorsal cutaneous nerve of thoracic segment 13, resulting in an innervated field surrounded by a denervated field. The innervated field was elevated as an innervated island flap and then subcutaneously embedded, with the skin paddle deepithelialized entirely (NSM group, n = 5) or except at the center (SSM group, n = 6). In the control model (CM group, n = 5), the flap was sutured back into its original position. Postoperative changes in the mechanonociceptive field were evaluated using the cutaneous trunci muscle reflex test. Immunohistochemical evaluation of regenerated nerves in the new mechanonociceptive field was performed at postoperative week 12. In the SSM and CM groups, the mechanonociceptive field expanded around the skin paddle. In the NSM group, a new mechanonociceptive field appeared at postoperative week 4 and expanded thereafter. Areas of the mechanonociceptive field at postoperative week 12 did not differ significantly between the SSM and NSM groups, but were significantly smaller compared with the CM group and comparable to original flap areas. Histologically, S100- and PGP9.5-positive nerve fibers were observed in the dermis of the new mechanonociceptive field and subcutaneous flap tissue. Subcutaneously embedded innervated island flaps induced nerve regeneration and sensory reinnervation of the denervated skin, suggesting that innervated flaps may also be useful in reconstruction post-SSM/NSM.

Patient satisfaction after nipple-sparing mastectomy with intraoperative radiotherapy and breast reconstruction for breast cancer

Introduction The use of nipple-sparing mastectomy (NSM) combined with breast reconstruction is increasing in breast cancer surgeries despite its controversial safety profile. To reduce the recurrence rate of tumors in the nipple-areola complex (NAC), we used intraoperative radiotherapy (IORT). The purpose of this study was to explore patients’ feedback on this novel treatment strategy. Patients and methods From January 2014 to May 2018, eligible patients with breast cancer were enrolled in this study and separated into 2 groups. Patients in the NSM group underwent IORT to the NAC flap, and patients in the skin-sparing mastectomy (SSM) group underwent SSM and breast reconstruction. The postoperative satisfaction was collected and assessed using the Breast-Q reconstruction questionnaire and a standardized questionnaire; this was compared between the 2 groups. Results There were 46 patients (52 NSMs) in the NSM group and 20 patients (22 SSMs) in the SSM group. The breast-Q scores were higher in the NSM group than the SSM group, with trends for a ‘higher satisfaction with breasts’ (67.39 ± 20.59 vs. 55.00 ± 19.33; p = 0.026) and ‘higher sexual well-being’ (61.74 ± 22.24 vs. 49.50 ± 20.12; p = 0.039). All the patients recognized the importance of nipple preservation. Thirty-seven women (80.40%) were satisfied or very satisfied with the appearance and shape of the NAC in the NSM group, while 38/46 women (82.60%) were very unsatisfied or unsatisfied with the sensitivity of the nipples. Conclusions The Breast-Q scores showed great satisfaction with breasts and sexual well-being in the NSM group. However, more effort should be made in improving postoperative NAC sensitivity.

Retrospective analysis between complication and nipple areola complex preservation in direct-to-implant breast reconstruction.

Since the introduction of skin-sparing mastectomy (SSM), more breast surgeons have been preserving the areola and often nipple areolar complex (NAC) entirely. For better outcomes, more studies are necessary to analyze whether preserving the areola or NAC is unfavorable in breast reconstruction. The aim of this study was to assess the potential risk of areola or NAC preservation in direct-to-implant (DTI) breast reconstruction after SSM. We retrospectively reviewed the medical records of patients who underwent immediate breast reconstruction from May 2011 to July 2017. Immediate breast reconstruction was performed with DTI procedure in all cases. In total, 213 breasts met the inclusion criteria and were divided into 3 groups: nipple-sparing mastectomy (NSM), aerola-sparing mastectomy (ASM) which only nipple is excised, and skin-sparing mastectomy (SSM) which whole NAC was excised. Complications including infection, capsular contracture, skin necrosis and explantation were measured. The mean patient age was 45.3 years, with a range of 27-62 years; the mean follow-up was 3.08 years. NSM, ASM and SSM groups consisted of 121, 30 and 62 breasts, respectively. The Infection rates were statistically lower in SSM group (4.8%) compared with NSM group (15.7%) (P=0.033) but not statistically different from ASM group (13.3%) (P=0.210). SSM group showed significantly lower rate of overall complication compared with both NSM and ASM groups (P=0.005, 0.025 respectively). Our research suggests that preservation of the NAC increases the rate of infection and skin necrosis in DTI breast reconstruction.

COMPARATIVE STUDY BETWEEN CONSERVATIVE BREAST SURGERY AND SKIN SPARING MASTECTOMY IN PATIENTS WITH MULTIFOCAL BREAST CANCER

Background: Breast cancer is by far the most common cancer among women of both developed and developing countries and the leading cause of cancer death in females. The incidence of multifocal breast cancer has increased due to the improvement in imaging studies and the use of MRI. Multifocal breast cancer was previously considered a contraindication for breast conservative surgery. However, with the recent progress in the neoadjuvant systemic therapy Together with development of oncoplastic surgeries breast conservation is being increasingly performed for multifocal cases. Skin sparing mastectomy can also be used for multifocal cases with superior aesthetic results without compromising the oncological safety. Aim of the work: This study aims to compare conservative breast surgery and skin sparing mastectomy in multifocal breast cancer regarding local recurrence. Patients and methods: This is a prospective randomized clinicaltrial study conducted in Ain-Shams University Hospitals Breast surgery unit over 30 patients with minimal follow-up of 18 months.2 groups of patients; Group A: composed of 15 patients that undergoing conservative breast surgery for multifocal breast cancer. Group B: composed of 15 patients that undergoing skin sparing mastectomy for multifocal breast cancer. An informed consent will be taken from all patients who will accept to participate. Results: The percentage of local recurrence were found to be comparable in both groups. Also the aesthetic results and patients’ satisfaction were similar in both groups. However, postoperative wound complications were higher in the skin sapring mastectomy group.Conclusion: This study suggests that any of the two procedures can safely be done to cases with multifocal breast cancer however the cosmetic results in skin sparing mastectomy group was more superior than in the conservative breast surgery group.

Abstract P2-14-17: Long-term oncologic safety of nipple-sparing mastectomy with immediate reconstruction

Abstract Background Nipple-sparing mastectomy (NSM) is an alternative procedure to skin-sparing mastectomy (SSM) for selected patients who undergo immediate reconstruction. However, the evidence of long-term oncologic safety of NSM has not been established. In this study, we aimed to compare the prognosis of breast cancer patients who underwent NSM to those who underwent SSM with immediate reconstruction. Methods The clinicopathological factors including recurrence site, pathologic stage, nipple-tumor distance, histological type, lymphovascular invasion, margin status, ER, PgR and HER2 status of stage 0–III primary breast cancer patients who underwent NSM or SSM with immediate primary reconstruction with tissue expander from our breast center database was retrospectively assessed. Patients with a nipple tumor distance of &amp;lt;1 cm who underwent NSM were excluded. 190 patients who underwent NSM and 729 patients who underwent SSM were included in the analysis. All patients underwent MRI or US before treatment. Nipple-tumor distance was mainly measured by MRI. Results The median follow-up period was 71 months (range: 10 - 131 months) for the NSM group and 79 months (range: 9 - 140 months) for the SSM group. There were no significant difference of clinicopathological factors between the NSM group and the SSM group, except of the larger diameter of tumor in the SSM group. NSM was performed for 60 patients (32%) with stage 0, 71 patients (37%) with stage I, and 59 patients (31%) with stage II/III. SSM was performed for 185 patients (26%) with stage 0, 268 patients (37%) with stage I, and 276 patients (37%) with stage II/III. Local recurrence was found in 11 (5.8%) patients in the NSM group and in 44 (6.0%) patients in the SSM group. In the NSM group, only one (0.5%) patient had local recurrence in the nipple areola complex. In terms of DFS and overall survival (OS) rate, there was no difference between the NSM group and the SSM group (DFS; 89.5% vs 89.2%, HR, 1.044; p = 0.8992; 95% CI, 0.5116–1.9519, and OS; 98.4% vs 96.4%, HR, 0.963; p = 0.9116; 95% CI, 0.473–1.793). According to breast cancer subtype, in the NSM group, all of the 11 patients (100%) who developed local recurrence in the NSM group was hormone receptor (HR)-positive/HER2-negative breast cancer. 29 of the 44 patients (65.9%) who developed local recurrence in the SSM group was HR-positive/HER2-negative, 6 patients (13.6%) was HR-negative/HER2-positive, and 7 patients (15.9%) was triple-negative breast cancer. Among patients who had received neoadjuvant chemotherapy, the NSM group (3 of 14 patients, 21.4%) had a trend for higher local recurrence rate than the SSM group 7 of 116 patients (6.0%) (p = 0.0813). However, no local recurrence in the nipple areola complex was observed for the NSM group. In addition, there was no difference of OS between the NSM group (92.9%) and the SSM group (90.5%) (HR, 0.903; p = 0.9943; 95% CI, 0.049-4.739). Conclusions Our results suggested that NSM with immediate reconstruction might be safe as well as SSM for breast cancer with the nipple–tumor distance of &amp;gt;1 cm with respect to their prognosis and local control regardless of breast cancer subtype or invasiveness. Further studies with a large sample size to assess the risk of local recurrence for NSM after neoadjuvant chemotherapy. Citation Format: Yamashita Y, Hayashi N, Nagura N, Kajiura Y, Yoshida A, Takei J, Suzuki K, Tsunoda H, Yamauchi H. Long-term oncologic safety of nipple-sparing mastectomy with immediate reconstruction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-17.

A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast

IntroductionDuctal carcinoma in situ (DCIS) accounts for 15% of all breast cancers and generally, the prognosis is good if treated optimally. The standard treatment includes breast conservative surgery along with adjuvant radiotherapy. Skin-sparing mastectomy (SSM) preserves the breast skin envelope but its oncological safety poses a few concerns. Moreover, no DCIS-specific studies have compared the local recurrence (LR) rate following total mastectomy (TM) or SSM. We evaluated the LR rate in DCIS patients who underwent either TM or SSM. MethodsThis is a retrospective study on women who underwent mastectomy with or without immediate breast reconstruction or secondary reconstruction for pure DCIS of the breast. All patients treated at Institut Bergonié by mastectomy for DCIS from January 1990 to December 2010 were included. LR and overall survival (OS) rates were estimated. ResultsThe study population included 399 patients who were categorized into two groups, 207 in the TM group and 192 in the SSM group. At 10 years of follow-up, the LR rate was 0.97% in the TM group and 1.04% in the SSM group (p = NS). The OS of the entire population was 94.7% [95% CI; 91.6–96.7], 92.8% [95% CI, 87.9–95.8] for the TM group and 96.8% [95% CI, 91.6–98.8] for the SSM group. ConclusionsIn our study, the LR rate following mastectomy is low, regardless of the surgical technique used, with an excellent OS at 10 years.

In the Age of Breast Augmentation, Breast Reconstruction Provides an Opportunity to Augment the Breast.

Background:Augmentation mammoplasty remains the most common cosmetic surgery procedure performed. The objective of this article is to evaluate the impact of augmented volume of the reconstructed breast in patients that undergo nipple-sparing mastectomy and patients previously augmented who undergo mastectomy with tissue expander/implant-based reconstruction.Methods:Patients undergoing skin-sparing mastectomy, nipple-sparing mastectomy, and mastectomy after previous augmentation followed by tissue expander/implant-based reconstruction between June 2011 and April 2015 by 2 surgeons at the same institution were included. Retrospective chart review of the patients identified using these criteria was performed to record patient characteristics, complications, breast volume, implant volume, and percentage change in volume at the time of reconstruction. Percentage change of breast volume was calculated using the formula (implant breast weight)/(breast weight) for skin-sparing and nipple-sparing mastectomy patients and (final breast implant weight − [breast weight + augmentation breast implant weight])/([breast weight + augmentation breast implant]) for patients undergoing mastectomy following previous augmentation.Results:A total of 293 patients were included in the study with 63 patients who underwent nipple-sparing mastectomy, 166 patients who underwent skin-sparing mastectomy, and 64 patients who underwent previous augmentation with subsequent mastectomy. Mean percentage change in breast volume was 66% in the nipple-sparing mastectomy group, 15% for the right breast and 18% for the left breast in the skin-sparing mastectomy group, and 81% for the right breast and 72% for the left breast in the mastectomy following previous augmentation group. Complication rate for nipple-sparing mastectomy was 27%, mastectomy following previous augmentation was 20.3%, and skin-sparing mastectomy group was 18.7%.Conclusion:Patients who undergo nipple-sparing mastectomy or mastectomy following previous augmentation have the ability to achieve greater volume in their reconstructed breast via tissue expander/implant-based reconstruction.

Nipple sparing mastectomy for breast cancer is associated with high patient satisfaction and safe oncological outcomes

BackgroundThe preservation of the nipple areolar complex (NAC) for cancer treatment is still a matter of debate because of suspected increase of local recurrence and surgery-specific complications. The aim of the study was to investigate both the relapse risk associated with nipple sparing mastectomy (NSM) for breast cancer and women's satisfaction with preservation of the NAC. MethodsWe included retrospectively all patients who had skin-sparing mastectomy (SSM) or NSM from 2007 to 2012 for breast cancer or ductal carcinoma in situ (DCIS). We compared NSM and SSM group for oncological and surgical outcomes. Patients’ satisfaction and quality of life has been evaluated by a specifically designed questionnaire. ResultsWe included 63NSM (41.5%) and 89SM (58.5%). Eighty-nine (58.6%) patients had DCIS, and the other had small invasive disease. Median follow-up was 42 (IQR: 18–58) months. Local recurrence rate was 1.7% (n=1) in the NSM group and 0% in the SSM group without recurrence in the preserved nipple. After NSM, one patient had complete NAC necrosis, and three patients suffered partial necrosis. Satisfaction with the NAC was higher in the NSM group compared to the SSM group with delayed reconstruction of the nipple (75% vs. 59%, P=0.14). Patients with NSM required less psychological support before (P=0.028) and immediately after surgery (P=0.14) than patients in the SSM group. ConclusionNSM can successfully and safely be performed for pre-invasive and small invasive breast cancer. Besides esthetic aspects, preserving the nipple may ease the acceptance of these radical form of surgery.

Oncologic Safety of Immediate Breast Reconstruction in Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy: Short-Term Outcomes of a Matched Case–Control Study

IntroductionAlthough the indication for immediate breast reconstruction (IBR) after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) has been expanded, IBR after neoadjuvant chemotherapy (NACT) is still controversial. We conducted retrospective matched case–control study to analyze oncologic outcomes between patients who underwent TM only and those who underwent IBR after SSM or NSM after NACT. Patients and MethodsA retrospective review of breast cancer patients who underwent IBR after SSM or NSM after NACT between 2008 and 2015 at a single center was conducted. These cases were maximally matched by 1:5 to patients who underwent total mastectomy (TM) alone after NACT. Matching variables included age, clinical T and N stage before NACT, response to NACT, and pathologic stage after NACT. Pathologic stage followed the 7th edition of the American Joint Committee on Cancer (AJCC) classification. ResultsOverall, 31 patients were enrolled onto the IBR after SSM or NSM group (study group) and matched to 85 patients (control group). In the study group, 13 patients (41.9%) underwent NSM and 18 (58.1%) underwent SSM. Median follow-up duration was 29.2 (range, 7-31) and 38.8 (range, 11-85) months for the study and control groups (P = .012), respectively, and median age was 37.0 (range, 26-57) and 40.0 (range, 24-56) years (P = .890), respectively. Overall survival (P = .971), disease-free survival (P = .520), distant metastasis-free survival (P = .795), and local recurrence-free survival (P = .628) did not differ significantly between the 2 groups. ConclusionIBR after SSM or NSM might be a feasible surgical treatment option even in breast cancer patients who underwent NACT.

Trends in mastectomy and reconstruction for breast cancer; a twelve year experience from a tertiary care center

BackgroundMany surgical options exist for breast cancer, including breast conserving therapy (BCT), mastectomy with reconstruction (MAST+RECON) or without reconstruction (MAST). Long-term results regarding oncologic outcomes are few and primarily retrospective studies. MethodsA retrospective review of a prospectively collected database of patients undergoing breast surgery for breast cancer from 2002 to 2014 was performed. Patients were separated into 3 time periods for analysis: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Recurrence outcomes were compared at 4 years between MAST+RECON patients. ResultsTwo thousand seventy-six patients were identified: 61.2% underwent BCT, 19.7% had MAST, and 19.1% had MAST+RECON. BCT patients were older and had smaller tumors.MAST+RECON increased in prevalence, whereas BCT decreased. Implant-based reconstruction and conservative mastectomy rates increased over the study period. Four-year local recurrence–free rates were similar in nipple-sparing and skin-sparing mastectomy groups. ConclusionsBCT usage has decreased, trending toward immediate, nipple-sparing mastectomy, implant-based reconstruction. Surgeons should be aware of trends to optimally offer patients their surgical options.

Patient Satisfaction and Nipple-Areola Sensitivity After Bilateral Prophylactic Mastectomy and Immediate Implant Breast Reconstruction in a High Breast Cancer Risk Population: Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy.

Prophylactic skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) both are associated with major risk reduction in women with high breast cancer risk. Skin-sparing mastectomy followed by nipple-areola complex (NAC) reconstruction is standard of care, but NSM is increasingly being performed. Preservation of the NAC in NSM may increase patient satisfaction. Therefore, we measured NAC sensitivity after NSM and compared patient satisfaction as well as body image after SSM with NSM. Women who underwent prophylactic bilateral SSM or NSM and immediate implant breast reconstruction between 2002 and 2012 were eligible. Patient satisfaction was assessed using the Breast-Q reconstruction questionnaire, body image using Hopwood's body image scale (BIS), and satisfaction with the (reconstructed) NAC using a study-specific questionnaire. In the NSM group, NAC sensitivity was assessed using Semmes Weinstein monofilaments with a 5-point scale and compared with NAC sensitivity in a nonoperated control group. The SSM group comprised 25 women (50 SSMs) and the NSM group 20 women (39 NSMs). Median follow-up was 65 months in the SSM group compared with 27 months in the NSM group (P < 0.01). In univariable analyses, Breast-Q scores were favorable in the SSM group compared with the NSM group with trends for higher "satisfaction with breasts" (66.2 vs 56.6; P = 0.06) and "satisfaction with outcome" (76.1 vs 61.5; P = 0.09). Mean BIS score of 7.1/30 in the SSM group and 9.3/30 in the NSM group (P = 0.35). Adjusted for follow-up, there were no significant differences in Breast-Q scores, nor in BIS scores. Interestingly, satisfaction with the (reconstructed) NAC was similar after SSM and NSM. Nipple-areola complex sensitivity was lower in the NSM group (mean score, 1.9; 95% confidence interval, 1.5-2.3) compared with the control group (mean score, 4.7; 95% confidence interval, 4.6-4.9; P < 0.01). Breast-Q scores regarding satisfaction with breasts and overall outcome were in favor of the SSM group. Residual NAC sensitivity after NSM was low. This suggests that SSM followed by NAC reconstruction is a balanced alternative to NSM. We observed no significant differences in body image and NAC-specific satisfaction between the NSM and SSM groups.

Abstract P2-13-09: Is nipple-sparing mastectomy with implant reconstruction for breast cancer safe and worthwhile?

Abstract Background: Nipple-sparing mastectomy (NSM) is a standard for bilateral prophylactic surgeries. However for cancer treatment, the preservation of the nipple areolar complex (NAC) is still discussed because of suspected increase of local recurrence and surgical specific complications as nipple or mastectomy flap necrosis. The aim of the study was to investigate both the relapse risk associated with NSM for breast cancer and women's satisfaction with preservation of the NAC. Methods: We included retrospectively all patients who had skin-sparing mastectomy (SSM) or NSM from 2007 to 2012 for breast cancer or ductal carcinoma in situ (DCIS). We compared NSM and SSM group for oncological (overall survival (OS) and disease-free survival (DFS)) and surgical outcomes. Patients' satisfaction and quality of life has been evaluated by a specifically designed questionnaire, addressed by mail and inspired by the Breast-Q questionnaire with specific assessment of global esthetic result, harmony with the native breast and need for psychological support. Results: During the study, we operated 5600 patients for a breast cancer, among them, 152 had NSM (n=63 / 41.5%) or SSM (n=89 / 58.5%) with immediate implant breast reconstruction. Eighty-nine (58.6%) patients had DCIS, and the other had invasive disease (86.9% of T1). The mastectomy has been indicated for primary cancer (81%) or recurrence (19%). The two groups did not differ significantly according to histological type (p=0.10), grade (p=0.84), hormonal receptor (p=0.7), HER2 (p=1.00), Ki67 (p=0.75) or node metastases (p=0.64). Median follow-up was 42 (IQR: 18-58 ) months. No cancer-related death occurred during the study. Local recurrence rate was 1.7% (n=1) in NSM group and 0% in SSM group (p=0.35). The recurrence did not appear on the preserved nipple. Severe complication requiring surgery (Grade 3 of Clavien-Dindo classification) occurred in 9.9% of the cases. In the NSM group, one patient had complete NAC necrosis and three patients suffered partial necrosis. Severe skin-flap necrosis leading to implant removal was more frequent in the SSM group (SSM: 6.7% (n=6) ; NSM: 0% (n=0); p=0.042). One hundred and four (80%) patients answered the questionnaire. Satisfaction about the aspect of the NAC was higher in the NSM group compared to SSM with delayed reconstruction of the nipple (75% vs 59%, p=0.14). Patients with NSM needed less psychological support before (p=0.028) and immediately after surgery (p=0.14) than patients in the SSM group, which may suggest a better acceptation of the surgery in this group. Conclusion: NSM for breast cancer surgery was not associated with significant increase of local recurrence rate or surgical complications. Patient's satisfaction was high. Therefore, nipple-sparing mastectomy with immediate implant reconstruction can successfully and safely be performed for pre-invasive and small invasive breast cancer. Besides esthetic aspects, preserving the nipple may ease the acceptation of these radical surgeries. Citation Format: Regis C, Mesdag V, Tresch E, Chauvet MP, Boulanger L, Collinet P, Giard S. Is nipple-sparing mastectomy with implant reconstruction for breast cancer safe and worthwhile?. [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 P2-13-09.

Abstract P5-17-05: Local recurrence rates after mastectomy undertaken for pure ductal carcinoma in situ

Abstract Currently over 30% of patients with ductal carcinoma in situ (DCIS) are treated by mastectomy. Local recurrence rates (LRR) after simple mastectomy for DCIS have historically been reported as low1. Recent UK and US data has indicated 5-year local recurrence rates after mastectomy for DCIS are increasing2. Skin sparing mastectomy (SSM) offers a better cosmetic outcome however there is little work in the literature comparing local recurrence rates between simple and SSM for pure DCIS. Local recurrence rates may be higher after SSM compared to simple mastectomy3. Aims: 1. To evaluate what local recurrence rates were after mastectomy performed for pure DCIS. 2. To compare LRR in simple against SSM. Methods: We undertook a retrospective analysis of all patients who underwent a mastectomy for pure DCIS at one breast unit between 2000-2010. Operation reports were reviewed and data collected on the type of mastectomy and reconstruction used. Pathology reports were reviewed and the histological type, grade, size of DCIS as well as the presence of micro-invasion, excision margin and molecular phenotype were recorded. We excluded those patients who were having surgery for recurrent ipsilateral disease, gynaecomastia and risk reduction. Results: One hundred and ninety-nine patients had a mastectomy to treat pure DCIS between 2000-2010. Median follow up time was 65 (0-152) months. 102 patients had an SSM compared to 97 who had a simple mastectomy. The mean age was younger in the SSM group 53 as opposed to 61 (p = &amp;lt;0.01, t-test). Overall local recurrence rates were 3.1% at 5 years and 5.6% at 8 years. Fiver-year contralateral recurrence rates were 4.2% and 8.5% at 8 years. All of the recurrences occurred in the SSM group which had 8/102 local recurrences compared to 0/97 in the simple mastectomy group. All 8 of the recurrence were invasive ductal carcinoma with a median disease free survival time of 55 months. Univariate analysis demonstrated that a young age and close margins predicted recurrence. Conclusion: Our overall 5-year local recurrence rate was 3.1%. This is higher than historical data however in line with emerging UK and US data. Five-year LRR was significantly higher after SSM 5.9% compared to simple mastectomy 0%. All recurrences were invasive disease, which represented a loss of control of disease. Further work is needed to evaluate if there is a benefit of undertaking post reconstruction mammography to detect recurrences whilst still in situ disease. Our work corroborates with the literature highlighting the importance of achieving clear margins to prevent recurrence.