Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy. Issue 5 (October 2015)

• Record Type: Journal Article
• Authors: Santoro, Stefano; Loreti, Andrea; Cavaliere, Francesco; Costarelli, Leopoldo; La Pinta, Massimo; Manna, Elena; Mauri, Maria; Scavina, Paola; Santini, Elena; De Paula, Ugo; Toto, Vito; Fortunato, Lucio
• Is Part Of: Breast. Volume 24:Issue 5(2015)
• Page Start: 661
• Page End: 666
• Publication Date: 2015-10
• Subjects: Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2015.08.001
• Languages: English
• ISSNs: 0960-9776

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH).</p> </sec> <sec> <title id="sectitle0020">Patients and methods</title> <p id="abspara0015">Among 275 NSMs performed from January 2007 to January 2015, 186 cases, with a minimum follow-up of 12 months, were carried out for invasive or intraductal carcinoma. Patients were considered for NSM if there were no clinical and radiological evidence of invasion or close proximity (<1 cm) to the nipple-areola complex (NAC). We compared patients operated with NSM after NCH (Group I N = 51) with those who underwent primary surgery (Group II, N = 135).</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">At a median follow-up of 35 months, 166/186 patients were alive and disease-free (89.7%). Three local relapses (1.6%) were observed, all in the skin flap outside the NAC in Group I: (6%; p < 0.01). No NAC recurrences have been recorded, in either group. Nipple loss due to full thickness necrosis or resection for insufficient margins was recorded in 31 cases (17%); 12 in Group I (24%) and 19 in Group II (14%) (P = 0.1). This event decreased by half in the second part of the study (21/93 vs 10/93) (P = 0.03).</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">NSM after NCH is not associated with a statistically significant difference in terms of post-operative complications, total nipple loss for necrosis or margins, and results improve with experience. The loco-regional relapse rate was higher after NCH, yet it was consistent with traditional mastectomy in the high-risk setting. There is no need to avoid NSM after NCH for locally advanced cancers, if the retro-areolar margins of resection are clear at the time of surgery.</p> </sec> </abstract>