Study: What is the risk of breast cancer recurrence after nipple-sparing mastectomy?
Contents
At a glance | In-depth |
Findings | Limitations |
Questions for your doctor | Resources |
STUDY AT A GLANCE
This study is about:
The risk of recurrence following nipple-sparing mastectomy among women with breast cancer.
Why is this study important?
When women have immediate breast reconstruction (at the same time as mastectomy) their breast tissue is removed, but most of the breast skin is retained to accommodate the reconstruction. A traditional mastectomy also removes the nipple and areola (the darker skin around the nipple). During breast reconstruction the surgeon can also recreate the nipple using the patient’s skin. Tattooing can be used to create the appearance of an areola.
With a nipple-sparing mastectomy (NSM) the surgeon saves the nipple and areola along with the breast skin. However, as a surgeon is performing a NSM, a sample of tissue immediately below the nipple-areola complex is examined by a pathologist. If this sample contains invasive cancer or , it is considered positive and the nipple is removed often with the areola. The advantage of NSM is cosmetic. NSM mastectomy incisions are usually made in the crease beneath the breast or horizontally from the areola towards the arm, so that after reconstruction, the new breasts appear to be unchanged.
While NSM improves cosmetic and psychological outcomes, many doctors and patients are concerned that sparing the nipple and areola may increase the risk for breast cancer recurrence, especially since the data on long-term risk of recurrence following NSM is limited. This study is important because it adds to a growing body of evidence suggesting that the long-term risk of local (in the tissue surrounding the breast), regional (to the ), and distant recurrence (in other parts of the body) following NSM is low.
Study findings:
Results from a large, single-institution study entitled "Oncologic Safety of Nipple-Sparing Mastectomy in Women with Breast Cancer" were published in the September 2017 issue of the Journal of the American College of Surgeons. This study followed outcomes of 2,182 NSMs performed at Massachusetts General Hospital from 2007 to 2016. Long-term outcomes were assessed in 311 patients with 0 to III breast cancer; however, 75% of patients followed were stage 0-I.
- At an average follow-up of 51 months, 17 patients (5.5%) had a recurrence.
- None of the patients in the study population (2,182) had a recurrence that involved the retained nipple or areola.
- At the time of surgery, the nipple margin contained tumor in 20 (6.4%) breasts.
- The rate of nipple loss due to necrosis was 1.7% for all NMS performed during this period.
In this study, the recurrence rate is comparable to that of standard mastectomy matched for stage and treatment. It is important to note that breast cancer rarely originates or recurs in the nipple, even in high-risk patients.
What does this mean for me?
For many women who face mastectomy, preserving their nipples allows them to keep an emotionally significant part of themselves that boosts their post mastectomy/reconstruction self-image. And although these women lose their own breast tissue, keeping their own nipples enhances the overall natural appearance of their reconstructed breasts. NSM also offers an added bonus: women can forego having new nipples surgically created as part of their reconstruction process. Anyone who has NSM should understand the risk of the procedure and the risk of recurrence related to retaining their nipples and/or areolas.
Importantly, not all women are candidates for NSM which is determined by the size and shape of the breast, location of the current nipple, previous history of radiation, body mass index, and location and size of the cancer. In this study, the body mass index was low suggesting that most patients were thin. Being overweight or obese may make some women ineligible for NSM.
Posted 1/25/18
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References
Smith BL, Tang R, Rai U, et al. “Oncologic Safety of Nipple-Sparing Mastectomy in Women with Breast Cancer.” Journal of the American College of Surgeons. 2017; 225(3):361-365.
“Nipple-Sparing Mastectomy Has Low Rate of Breast Cancer Recurrence.” Press Release from the Journal of the American College of Surgeons.
Disclosure
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
This article is relevant for:
Breast cancer patients who are considering or have had a nipple sparing mastectomy
This article is also relevant for:
previvors
people with triple negative breast cancer
people with ER/PR + cancer
people with Her2-positive cancer
people with a genetic mutation linked to cancer risk
people with breast cancer
Be part of XRAY:
- Am I a good candidate for NSM?
- What will my nipple look and feel like after NSM?
- What is my risk of my breast cancer returning after NSM?
- Are there other risks with the procedure?
The following studies are related to mastectomy and breast reconstruction.
- NCT05720039: Nipple-Sparing Mastectomy With Immediate Implant-Based Reconstruction for Women With Early-Stage Breast Cancer. This study will compare robotic-assisted nipple-sparing mastectomy (NSM) to standard surgery NSM for women with early-stage breast cancer.
- NCT02918474: Decision-Making Tool in Supporting Decision-Making in Contralateral Prophylactic Mastectomy in Patients With Newly Diagnosed Breast Cancer. This trial studies the acceptability and usefulness of a tool that supports decision-making for contralateral prophylactic mastectomy in patients with newly diagnosed breast cancer.
- NCT04533373: Sensory Restoration After Flap Neurotization. The goal of this study is to look at whether nerve graft works to improve sensation in the breast after mastectomy with DIEP flap reconstruction.
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NCT05020574: Microbiome and Association With Implant Infections. This study is looking at whether people with high amounts of certain types of bacteria are more likely to develop tissue expander-related infections than those with lower amounts of bacteria.
Updated: 11/20/2023
The following resources can help you find a plastic surgeon who specializes in breast reconstruction:
Finding a plastic surgeon
- The American Society of Plastic Surgeons has a searchable Plastic Surgeon Referral Service database.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The website for The Complete Guide to Breast Reconstruction provides information on Choosing the Right Surgeon.
Updated: 11/20/2023
Who covered this study?
Healthline
More women with breast cancer opting for nipple-sparing mastectomies
This article rates 5.0 out of 5 stars
US News and World Report
'Nipple-sparing' mastectomies don't raise odds of cancer's return: study
This article rates 4.0 out of 5 stars
Bel Marra Health
Study finds low rate of breast cancer recurrence after nipple-sparing mastectomy
This article rates 3.0 out of 5 stars