A large meta-analysis that included 5,276 patients found that mastectomies that preserve the nipple plus an envelope of breast skin are as safe as surgeries that remove even more tissue. The results of the study were presented at the 16th Annual Meeting of the American Society of Breast Surgeons (ASBS), held April 29–May 3, in Orlando, Florida.
Lucy De La Cruz, MD, of the University of Miami, presented the results at a press briefing. Cruz and colleagues reviewed 19 publications from 1991 to 2014 and found that the overall survival (OS) and disease-free survival (DFS) of patients who received a nipple-sparing mastectomy was similar to that of women who had more radical surgery.
OS in these studies ranged from 76.7% to 100%, and DFS ranged from 51.3% to 100%. Nipple-areolar recurrence (NAR) ranged from 0% to 5.4% and was generally lower than local recurrence.
Patients followed for less than 3 years had a mean OS of 98.6%, DFS of 95.9%, local recurrence of 3.9%, and NAR of 0.6%.
Those followed for 3 to 5 years had a mean OS of 97%, DFS of 93.2%, local recurrence of 1.2%, and NAR of 0.5%.
Those followed for over 5 years had a mean OS of 90.8%, DFS of 89.9%, local recurrence of 8.5%, and NAR of 2.1%.
A nipple-sparing mastectomy is similar to a standard mastectomy, but the surgery spares the nipple and areola. Both traditional and nipple-sparing mastectomies are followed by immediate surgical reconstruction.
According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, the rate of nipple-sparing mastectomies has increased by 202% from 2005 to 2009.
There is a safety concern with this type of surgery because of the potential for residual cancer to remain in the tissue. Previous studies have shown that the occult malignancy in the nipple-areolar tissue range from 0% to 53% with a mean of 11.5%.
Nipple-preserving surgery is not for all patients—those whose cancer is close to the nipple are at higher risk of having cancer cells remain in the breast tissue, and this technique is also not ideal for those women with large breasts because of the post-mastectomy cosmetic effect. Those women who have opted for prophylactic mastectomies due to a high risk of breast cancer as a result of hereditary factors are typically candidates for nipple-sparing mastectomy.
Eight of the studies included had a comparator surgical arm. Of the six studies that compared OS, there was a 2.5% risk difference favoring nipple-sparing mastectomy (over skin-sparing mastectomy or modified radical mastectomy).
Of the three studies that compared DFS, there was a 4.4% risk difference favoring nipple-sparing mastectomy over the other two techniques.
The use of the prospective Nipple-Sparing Mastectomy Registry and other registries should add additional information that will better address the question of whether sparing the nipple plays a role in breast cancer recurrence, said Cruz during her presentation. Additionally, randomized trials would provide even further evidence on whether these two surgical approaches have similar survival outcomes.