USA: Nipple-Sparing Mastectomy (NSM) Study

Nipple-sparing mastectomy (NSM) may lower the long-term risk of recurrent breast cancer and helps to achieve good cosmetic outcomes in women with breast cancer, a study in Plastic and Reconstructive Surgery has reported.

The researchers showed that after ten years of NSM, the rate of recurrent breast cancer was only 3%. "Nipple-sparing mastectomy remains a viable option in the appropriately indicated patient with regards to long-term cancer recurrence," ASPS Member Surgeon Mihye Choi, the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, and colleagues wrote in their study.

Not Just Improved Cosmetic Outcomes - Breast Cancer NSM Provides Good Long-Term Cancer Control

In the NSM technique, the surgeon preserves the nipple and surrounding tissues for use in immediate breast reconstruction. Compared to conventional mastectomy, NSM allows for a more natural-looking reconstruction, leading to higher patient satisfaction. However, there is little information about the long-term risk of recurrent breast cancer after NSM.

Dr. Choi and colleagues evaluated breast cancer outcomes in 120 patients undergoing NSM for breast cancer treatment. The analysis included a total of 126 therapeutic NSM procedures. The analysis excluded prophylactic (preventive) NSM procedures to reduce the risk of breast cancer in women at high genetic risk.

At a median follow-up of 10 years after NSM, the analysis showed low recurrent cancer risks: 3.33% per patient and 3.17% per reconstructed breast. Of the four patients with recurrent cancer, two had local recurrences (breast only) and two had cancer spread to other locations (locoregional recurrence).

Recurrence risk was higher for women who had cancer involving the lymph nodes. However, on analysis adjusting for other factors, there were no demographic, surgical, or tumor-related variables that predicted the risk of recurrent breast cancer.

The researchers point out some key limitations of their findings—including selection bias related to the characteristics of patients likely to be considered good candidates for NSM. Most of the patients in the study had early-stage breast cancers: stage 1 in about 45% and stage 0 in 34%.

The finding of good long-term cancer control is especially important in light of the growing use of NSM and immediate reconstruction for women with breast cancer. "Patients with NSMs have had low locoregional recurrence rates in a retrospective review of patients with a median follow-up of 10-years," Dr. Choi and colleagues conclude. They add: "Despite low rates of recurrence, close surveillance remains important to continually assess for long-term safety of NSM."

Reference

Boyd, Carter J. M.D., M.B.A.; Salibian, Ara A. M.D.; Bekisz, Jonathan M. M.D., M.Sci.; Axelrod, Deborah M. M.D.; Guth, Amber A. M.D.; Shapiro, Richard L. M.D.; Schnabel, Freya R. M.D.; Karp, Nolan S. M.D.; Choi, Mihye M.D.. Long-Term Cancer Recurrence Rates following Nipple-Sparing Mastectomy: A 10-Year Follow-Up Study. Plastic and Reconstructive Surgery: October 2022 - Volume 150 - Issue - p 13S-19S doi: 10.1097/PRS.0000000000009495