Wu ZY et. al.

Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer.

JAMA Surg. 2019 Aug 28
https://jamanetwork.com/journals/jamasurgery/article-abstract/2749070

A recent study addressed the level of risk associated with nipple-sparing mastectomy for the treatment of breast cancer. Researchers found that the risk of cancer returning at the nipple-areola area depends on multiple factors related to the biology of the tumor.

A nipple-sparing mastectomy, when performed for breast cancer, removes the underlying breast tissue while preserving the overlying skin, nipple, and areola. In contrast, both a skin-sparing mastectomy and total mastectomy involve removing the nipple and areola. Keeping the nipple can improve the cosmetic result following immediate breast reconstruction. The concern with a nipple-sparing mastectomy is the potential risk of cancer returning within the area of the saved nipple/areola (i.e., nipple-areolar complex or NAC).

The study, performed at the Asian Medical Center in Korea and published in JAMASurgery, consisted of a review of 944 patients who underwent a nipple-sparing mastectomy for invasive breast cancer. From this group, there were 39 cases of cancer returning at the NAC. The 5-year overall rate of cancer recurrence at the NAC was found to be relatively low (3.5%).

Risk factors associated with this outcome after surgery include having cancer in multiple areas of the breast, more aggressive tumors (i.e., higher grade and HER2 positive), estrogen-receptor negative cancer, and cancer with large amounts of microscopic extension (i.e., DCIS with extensive intraductal component).

Comparing patients who had cancer recurrence at the NAC to those who did not have cancer recurrence did not demonstrate any statistically significant differences concerning survival.

The findings suggest that the biological features of breast cancer should be taken into consideration when making decisions about nipple-sparing mastectomy. The procedure may be a safe option in appropriately selected patients.