Get notified of page updates

Study: What is the risk of breast cancer recurrence after nipple-sparing mastectomy?

Printer Friendly Page Read the Original Article

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

Share your thoughts on this XRAYS article by taking our brief survey

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:

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • 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?

Open Clinical Trials
Open Clinical Trials

The following studies are related to mastectomy and breast reconstruction.

Updated: 11/20/2023

Find Experts
Find Experts

The following resources can help you find a plastic surgeon who specializes in breast reconstruction:

Finding a plastic surgeon

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

How we rated the media

Back to XRAY Home