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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 | | Race | Caucasian: 127 (85.2%)
Non-Caucasian: 22 (14.8%) | | BMI | 24.28 | | Tobacco History | 7 (4.7%) | | Radiation History | 8 (5.4%) | | BRCA 1/2 Status | 10 (6.7%) | | Family History | 38 (25.5%) | | Unilateral vs. Bilateral NSM | Unilateral: 76 (51.0%)
Bilateral: 73 (49.0%) | | Indication for Mastectomy | Therapeutic: 126 (84.6%)
Prophylactic: 23 (15.4%) | | Neoadjuvant Therapy | 6 (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 Stage | Stage 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 Status | ER (+): 90 (60.4%)
PR (+): 79 (53.0%)
Her 2/neu (+): 6 (4.0%)
Ki-67 (High): 35 (23.5%) | | Positive Nodal Status | 22 (14.8%) |
Table 3: NSM Complications per Patient | | | Positive Subareolar Biopsies | Frozen Section: 6 (7 breasts) (4.0%)
Permanent Section: 2 (1.3%) | | Mastectomy Flap Necrosis | 12 (8.1%) | | Nipple-Areola Complex Necrosis | Partial-Thickness: 2 (1.3%)
Full-Thickness: 1 (0.67%) | | Nipple-Areola Complex Excision (Patient Preference) | 1 (0.67%) | | Implant Extrusion | 4 (2.7%) | | Cellulitis | Oral Antibiotics: 12 (8.1%)
Intravenous Antibiotics: 2 (1.3%) | | Hematoma | 4 (2.7%) | | Seroma | 3 (2.0%) | | Wound Dehiscence | 1 (0.67%) | | Capsular Contracture | 2 (1.3%) | | Thoracodorsal Nerve Spasm | 1 (0.67%) | | Microvascular Free Flap Failure | 1 (0.67%) |
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