Retrospective Update on Nipple-Sparing Mastectomy
Posted: Friday, May 31, 2019
Based on a retrospective study of nipple-sparing mastectomy performed on more than 1,300 breasts in more than 750 women, the rates of complications and implant failure associated with this surgery have decreased significantly since the introduction of the procedure. This finding should be considered in light of the fact that these patients increasingly included those with more advanced cancers and women traditionally considered at risk for postoperative difficulties. These findings were presented at the 2019 Annual Meeting of the American Society of Breast Surgeons (ASBrS) in Las Vegas.
“Research continues to validate the oncologic safety and enhanced cosmesis of nipple-sparing mastectomies,” lead researcher Tina Hieken, MD, of the Mayo Clinic, Rochester, Minnesota, said in an ASBrS press release. “The results of this study were striking. It not only confirmed this but showed that these surgeries can safely be offered to a far more diverse and challenging group of well-selected patients.”
The researchers identified 1,301 breasts of 769 women who retained their nipples and skin for breast reconstruction after mastectomy from 2009 to 2017. The overall 30-day complication rate for patients was 7.5% and declined from 14.8% in 2009 to 6.3% in 2017. That decrease occurred despite a significant increase over time in the number of patients with obesity and treatment with neoadjuvant chemotherapy. At 1 year, reconstruction success was 98.5% among 1,281 evaluable breasts in 2017, up from 87% in 2009.
Obesity was not associated significantly with outcomes after 2013. Prior radiation and recent or current smoking significantly increased the risk of 30-day complications, which ranged from surgical-site infections, hematomas and seromas requiring surgery, necrosis requiring tissue removal, and unplanned additional surgeries.
“Nipple-sparing mastectomies are difficult procedures, requiring highly perfected skill sets and engagement from the entire surgical team,” noted Dr. Hieken. “Breast surgeons, reconstructive plastic surgeons, oncologists, and skilled nurses must be committed and practiced at working seamlessly as a group to make these surgeries a success.”
Disclosure: The study author’s disclosure information can be found at breastsurgeons.org.