Experience with nipple-sparing mastectomy after prior whole-breast radiation.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 173-173
Author(s):  
Aimee Marlena Mackey ◽  
Bret Taback ◽  
Preya Ananthakrishnan ◽  
Sheldon M. Feldman
Keyword(s):  
Breast Cancer ◽  
Brca Mutation ◽  
Breast Cancers ◽  
Ipsilateral Breast ◽  
Immediate Reconstruction ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Good Cosmesis

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]

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

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.

scholarly journals Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

Genes ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 253
Author(s):  
Nicola Rocco ◽  
Giacomo Montagna ◽  
Carmen Criscitiello ◽  
Maurizio Bruno Nava ◽  
Francesca Privitera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brca Mutation ◽  
Immediate Breast Reconstruction ◽  
Point Of View ◽  
Breast Cancers ◽  
Oncological Safety ◽  
Brca Mutation Carriers ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Risk Reducing

Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.

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

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 60-60 ◽  
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.

Oncologic Outcomes of Nipple-sparing Mastectomy and Immediate Reconstruction After Neoadjuvant Chemotherapy for Breast Cancer

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Zhen Yu Wu ◽  
Hee-Jeong Kim ◽  
Jong-Won Lee ◽  
Il-Yong Chung ◽  
Ji-Sun Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Oncologic Outcomes ◽  
Immediate Reconstruction ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

scholarly journals Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Zoran Radovanovic ◽  
Milan Ranisavljevic ◽  
Dragana Radovanovic ◽  
Ferenc Vicko ◽  
Tatjana Ivkovic-Kapicl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Complications ◽  
Late Complication ◽  
Oncological Outcome ◽  
Primary Implant ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Implant Reconstruction

Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m2, and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

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