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.
Nipple-sparing mastectomy: external validation of a three-dimensional automated method to predict nipple occult tumour involvement on preoperative breast MRI
