Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: A prospective trial with 13 years median follow-up in 216 patients

173 Background: Nipple-sparing mastectomy (NSM) is being performed more frequently for risk reduction and breast cancer treatment. Prior whole breast irradiation (WBI) has been considered a contraindication to NSM. This study reviews our NSM experience following prior WBI. Methods: We reviewed our prospective mastectomy database from April 2007 to April 2012 for patients undergoing NSM. Ten patients out of a total 169 NSM were identified that underwent NSM following prior WBI. Data collected included incision type, follow-up, complications, cosmesis, and recurrence. Results: Of the ten NSM patients who received prior WBI, 6 had recurrent ipsilateral breast cancer at the lumpectomy site, 3 developed contralateral breast cancers and opted for bilateral NSM, and 1 patient opted for bilateral NSM after finding a BRCA mutation following BCT. Mean patient age was 53. Two patients had comorbities: 1 hyperlipidemia and 1 former smoker. Three of 10 (30%) developed complications, with 2 partial necrosis of nipple-areola complex (NAC) and 1 complete loss of the NAC (Table). No patient required return to the operating room (local resection in the office was performed for the complete NAC loss) and all patients had good final cosmesis. All patients underwent immediate reconstruction: 5 tissue expanders (TE), 2 DIEP and 3 TRAM flaps. Mean follow up is 23 months with no local recurrences to date. Conclusions: This study demonstrates that NSM with immediate reconstruction can be performed in selected patients with prior WBI with an acceptable rate of nipple preservation and good cosmesis. NAC preservation is the ultimate goal in patients undergoing NSM. Current studies are ongoing to identify risk factors that may be associated with nipple necrosis. [Table: see text]

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O-75 Survival in breast cancer after nipple-sparing subcutaneous mastectomy: a prospective study with 13 years follow-up in 216 patients

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(07)71765-2 ◽

2007 ◽

Vol 5 (3) ◽

pp. 23

Author(s):

K.P. Benediktsson ◽

L. Perbeck

Keyword(s):

Breast Cancer ◽

Prospective Study ◽

Subcutaneous Mastectomy ◽

Nipple Sparing ◽

A Prospective Study

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Nipple-sparing mastectomy and immediate reconstruction: Indications, technique, and results of 110 patients with breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.11088 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 11088-11088

Author(s):

B. Son ◽

S. Ahn ◽

H. Kim ◽

M. Jang ◽

E. Park ◽

...

Keyword(s):

Breast Cancer ◽

Resection Margin ◽

Breast Conserving Surgery ◽

Immediate Reconstruction ◽

Cosmetic Results ◽

Oncological Safety ◽

Tumor Involvement ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

11088 Background: Nipple-sparing mastectomy (NSM) and immediate reconstruction has recently been accepted as a new surgical procedure that provides good cosmetic results, although it is necessary to establish oncological safety. We reported our experience to evaluate indications, technique, results, and complications of NSM. Methods: Between 1999 and 2005, medical records of 113 patients with breast cancer undertaken NSM at the Asan Medical Center were analyzed retrospectively. Median age of the patients was 40 years and complications were assessed 3 months later postoperatively. Results: For preoperative indications of NSM, mulifocal or multicentric cancers were 60 cases (53.1%), diffuse microcalcifications on MMG were 27 cases (23.9%), failure of breast conserving surgery due to tumor involvement of resection margin were 12 cases (10.6%), central located small cancers were 11 cases (9.7%). Immediate reconstruction methods were 85 cases (75.2%) in TRAM and 28 cases (24.8%) in direct implant. Intraoperative frozen section biopsy for evaluation of tumor involvement at the NAC showed accuracy of 100%. Pathologic tumor size were 24 cases (21.2%) in Tis, 56 cases (49.6%) in T1, 33 cases (29.2%) in T2, respectively. Lymph node status showed 81 cases (71.7%) in N0, 24 cases (21.2%) in N1, 7 cases (6.2%), and one case (0.9%) in N3, respectively. During 20 months of the median follow-up, four patients developed recurrences; one local recurrence (subcutaneous), two (lung, brain) distant failures, and one local and distant failure. The rate of major NA necrotic complication was 14.6%, but all cases were improved with conservative management. 91.7% of patients were satisfied with their cosmetic results. Conclusions: Although the presented study does not establish conclusion with regard to oncological safety due to short follow-up period, the procedure of NSM with intraoperative pathologic assessment of the subareola tissue, and immediate reconstruction is a reasonable option for a selected patients. Good candidates for NSM are patients unsuitable for breast conservation either for multicentric or multofocal cancers, or because of extensive microcalcification, or involvement of resection margin during breast conserving surgery. No significant financial relationships to disclose.

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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

10.1158/1538-7445.sabcs15-p2-12-09 ◽

2016 ◽

Author(s):

T Sakurai ◽

T Suzuma ◽

G Yoshimura ◽

E Jinta ◽

T Umemura ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Single Center ◽

Single Center Study ◽

Long Term Follow Up ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Center Study

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Final Results of Phase I Study of Prophylactic Nipple-Areola Complex Radiation Therapy after Nipple Sparing Mastectomy and Immediate Reconstruction for Breast Cancer or DCIS Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.157 ◽

2018 ◽

Vol 102 (3) ◽

pp. S226-S227

Author(s):

C. Takita ◽

I.M. Reis ◽

D. Yakoub ◽

Z. Panthaki ◽

C. Boneti ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Phase I ◽

Phase I Study ◽

Immediate Reconstruction ◽

Nipple Areola Complex ◽

Areola Complex ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Outcomes and feasibility of nipple-sparing mastectomy for node-positive breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.60 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 60-60 ◽

Cited By ~ 1

Author(s):

Brittany L. Murphy ◽

Tanya L. Hoskin ◽

Judy Caroline Boughey ◽

Amy C. Degnim ◽

James W. Jakub ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Oncologic Outcomes ◽

Her2 Status ◽

Breast Cancer Patients ◽

Node Positive ◽

Primary Surgery ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

60 Background: Indications for nipple-sparing mastectomy (NSM) with immediate reconstruction have expanded. For cancer patients, NSM is thought best-suited for early stage patients, with nodal involvement initially viewed as a relative contraindication. We undertook this study to evaluate the use and early outcomes of NSM in node-positive (LN+) breast cancer. Methods: We identified 240 cancers in 226 patients (14 bilateral) scheduled for NSM and operated on at our institution 1/2009-6/2014. Data on intraoperative conversion from NSM, recurrence and follow-up was abstracted from the medical record. Chi-square and long-rank tests were used for statistical analysis. P-values < 0.05 were considered significant. Results: Of 240 cancers, 182 were LN- and 58 were LN+. More LN+ patients had T2/T3 tumors (27/58, 47%) than LN- patients (31/182, 17%), p < 0.0001, but ER and HER2 status was similar. Of 58 LN+ cases, 19 (33%) were cN1 confirmed by positive LN cytology and 39 (67%) were cN0 but LN+ at operation. 10 patients LN+ at diagnosis received neoadjuvant therapy (NT) followed by operation (at which 6 were pLN+ and 4 rendered ypN0); 39 cN0 (4 NT, 35 primary surgery) and 9 cN1 primary surgery patients were pLN+ at operation with a median of 1 LN+. NSM was successful in 13/14 LN+ NT patients (93%) and 39/44 LN+ primary surgery patients (89%), p = 0.64. Six LN+ patients (10%) were converted to skin-sparing mastectomy (SSM) at initial operation based on frozen section pathology (n = 5) or at a second operation (n = 1) vs 13/182 LN- patients (7%), p = 0.44. Among cancer patients treated with NSM, 7 locoregional recurrences (5 in LN+, 2 in LN- patients) occurred at 25 mos median follow-up. 3-year locoregional disease-free estimates were 87% (95% CI 75-100%) for LN+ vs 99% (95% CI 97-100%) for LN- patients, p = 0.007. One nipple-areolar recurrence occurred, in a LN- patient. 3-year breast cancer-specific survival was 97% (95% CI 92-100%) in LN+ vs 99% (95% CI 98-100%) in LN- patients, p = 0.40. Conclusions: Conversion from planned NSM to SSM did not differ significantly between LN+ and LN- patients. Short-term oncologic outcomes were satisfactory. These data suggest that NSM may be appropriate for carefully selected LN+ breast cancer patients.

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Locoregional recurrence following pathologic complete response in patients with T1-3 N0 breast cancer treated with neoadjuvant chemotherapy, breast conserving surgery and whole breast radiation: Is a trial of omission of radiation warranted?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e12625 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e12625-e12625

Author(s):

Elena Parvez ◽

Thierry Muanza

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Endocrine Therapy ◽

Locoregional Recurrence ◽

Prospective Trial ◽

Pathologic Complete Response ◽

Complete Response ◽

Breast Conserving Surgery ◽

Study Objective

e12625 Background: Pathologic complete response(pCR) after neoadjuvant chemotherapy(NAC) in patients with breast cancer(BC) is associated with decreased recurrence and improved survival. In NSABP B18 and B27, 10-yr locoregional recurrence(LRR) after pCR in patients with Stage I-III BC undergoing breast conserving surgery(BCS) and whole breast RT(WBRT) was 5.2-6.9%. However, LRR may be overestimated as Her2 therapy was not used and only some eligible patients received endocrine therapy. A retrospective study using modern protocols found a 5-yr LRR of up to 2.6%. We hypothesize that LRR in N0 patients is even lower, and de-escalation of therapy should be examined. The study objective is to assess if a prospective trial of omission of WBRT after BCS in patients with N0 BC and pCR after NAC is warranted and to assess feasibility. Methods: Patients with T1-T3 N0 invasive BC diagnosed between Dec 2011-2017 treated with NAC and BCS were identified from a hospital BC registry. Health records were retrospectively reviewed to identify patients with pCR, defined as absence of residual invasive or in-situ disease(ypT0N0). Incidents of locoregional and distant recurrence were recorded. Results: Of 89 patients with T1-3 N0 invasive BC treated with NAC and BCS, 29(32.6%) had pCR. Median follow-up was 61.1 months. Median age was 55 yrs and median tumour size was 2.4cm. Receptor status was 16(55.2%) HR-Her2-, 4(13.8%) HR-Her2+, 7(24.1%) HR+Her2+ and 2(6.9%) HR+Her2-. NAC protocols consisted of an anthracycline and/or a taxane in 27(90%) patients, and 6 patients were treated on NAC trials. All patients with Her2+ disease received Her2 targeted therapy. Adjuvant endocrine therapy was taken by 8 of 9 patients with HR+ disease. All patients received WBRT without nodal RT. RT plan was available for 26(86.7%) patients. RT dose ranged from 40-50Gy, and all but 4 received tumour bed boost. There were no local or regional recurrence events at last follow-up. One patient developed brain metastases at 15.7 months. Conclusions: Over 6 years, 29 patients were identified that would be eligible for a prospective trial evaluating omission of WBRT after pCR in N0 patients treated with NAC and BCS. At median 5-yr follow-up, there were no locoregional recurrences in our cohort, demonstrating that the absolute benefit provided by WBRT is likely small. Our results indicate a prospective trial is warranted and will require multi-institution participation to accrue.

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