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Examining Oncologic Outcomes after Nipple-Sparing Mastectomy: A Single-Institutional Experience
Jordan D. Frey, MD, Michael Alperovich, MD, Jennifer C. Kim, MPH, Jamie P. Levine, MD, Pierre B. Saadeh, MD, Alexes Hazen, MD, Christina Y. Ahn, MD, Robert J. Allen, Sr., MD, Deborah M. Axelrod, MD, Richard L. Shapiro, MD, Mihye Choi, MD, Nolan S. Karp, MD, Freya R. Schnabel, MD, Amber A. Guth, MD.
NYU Langone Medical Center, New York, NY, USA.

Introduction:
Long-term oncologic outcomes in nipple-sparing mastectomy (NSM) continue to be defined. Rates of locoregional recurrence for skin-sparing mastectomy (SSM) and NSM in the literature range from 0 to 11.7%. We investigated the outcomes of NSM at our institution.
Methods:
Patients undergoing NSM at our institution from 2006 to 2014 were identified. Patient demographics, tumor characteristics, and outcomes were collected. Locoregional recurrence was compared to published NSM and SSM results compiled from 14 and 11 studies.
Results:
From 2006 to 2014, 319 patients (555 breasts) underwent NSM. 149 patients had long-term follow-up available. Patient demographics and tumor characteristics are demonstrated in Tables 1 and 2. Average patient follow-up was 30.72 months. There was one (0.7%) incidence of ipsilateral chest-wall recurrence in a 44 year-old (p<0.0001, compared to aggregate NSM and SSM data). There were 0.36 complications per patient (Table 3).
Conclusions:
We examined our institutional outcomes with NSM and found a locoregional recurrence rate of 0.7% with no nipple-areolar complex recurrence. This rate is significantly lower than aggregate published rates for both NSM and SSM.
Tables:
Table 1: Patient Demographics
Age (years)47.7
RaceCaucasian: 127 (85.2%)
Non-Caucasian: 22 (14.8%)
BMI24.28
Tobacco History7 (4.7%)
Radiation History8 (5.4%)
BRCA 1/2 Status10 (6.7%)
Family History38 (25.5%)
Unilateral vs. Bilateral NSMUnilateral: 76 (51.0%)
Bilateral: 73 (49.0%)
Indication for MastectomyTherapeutic: 126 (84.6%)
Prophylactic: 23 (15.4%)
Neoadjuvant Therapy6 (4.0%)
Follow-Up (months) (Range)30.72 (57.6-8.28)

Table 2: Tumor Characteristics
Tumor Size (cm)1.41
Histologic Type (Percent of Therapeutic NSM)IDC: 82 (66.7%)
DCIS: 30 (23.8%)
ILC: 7 (5.6%)
Invasive Other: 6 (4.8%)
Mixed Type: 1 (0.8%)
Pathologic StageStage 0: 52 (34.9%)
Stage I: 54 (36.2%)
Stage IIA: 14 (9.4%)
Stage IIB: 8 (5.4%)
Stage IIIA: 3 (2.0%)
Stage IIIC: 1 (0.7%)
Receptor StatusER (+): 90 (60.4%)
PR (+): 79 (53.0%)
Her 2/neu (+): 6 (4.0%)
Ki-67 (High): 35 (23.5%)
Positive Nodal Status22 (14.8%)

Table 3: NSM Complications per Patient
Positive Subareolar BiopsiesFrozen Section: 6 (7 breasts) (4.0%)
Permanent Section: 2 (1.3%)
Mastectomy Flap Necrosis12 (8.1%)
Nipple-Areola Complex NecrosisPartial-Thickness: 2 (1.3%)
Full-Thickness: 1 (0.67%)
Nipple-Areola Complex Excision (Patient Preference)1 (0.67%)
Implant Extrusion4 (2.7%)
CellulitisOral Antibiotics: 12 (8.1%)
Intravenous Antibiotics: 2 (1.3%)
Hematoma4 (2.7%)
Seroma3 (2.0%)
Wound Dehiscence1 (0.67%)
Capsular Contracture2 (1.3%)
Thoracodorsal Nerve Spasm1 (0.67%)
Microvascular Free Flap Failure1 (0.67%)


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