No significant evidence of breast cancer after nipple-sparing mastectomy

A modified mastectomy technique provides effective treatment for breast cancer while preserving the nipple and surrounding tissues for use in breast reconstruction, according to a report in the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

More than two decades of research shows no significant evidence of breast cancer developing after nipple-sparing mastectomy for the treatment or prevention of breast cancer, reports the study, led by Dr. Scott L. Spear of Georgetown University Hospital.

No Problems with Cancers Related to Nipple-Sparing Surgery

Dr. Spear and colleagues report their hospital's experience with nipple-sparing mastectomy from 1989 to 2010. During this period, a total of 162 nipple-sparing mastectomies were performed in 101 women. Thirty percent of the operations (49 operations in 48 patients) were performed for treatment of diagnosed breast cancer.

The remaining 70 percent of nipple-sparing mastectomies (113 operations in 80 patients) were performed on women at high risk of breast cancer undergoing preventive mastectomy.

In nipple-sparing mastectomy, the nipple and surrounding tissues are preserved for use in reconstructing the breast. The breast reconstruction is generally performed immediately after mastectomy.

Nipple-sparing mastectomy has potentially important benefits in terms of patient satisfaction and body image, as well as fewer operative procedures and complications. However, the procedure has been slow to catch on because of perceived safety risks—especially the concern that the preserved tissue might be a source of breast cancer cells. To address these concerns, Dr. Spear and colleagues sought to provide objective data on the risks and outcomes of nipple-sparing mastectomy.

Biopsy Is Key to Detecting Possible Cancer Cells

A key part of the procedure was analyzing a sample of the tissue from under the nipple before reconstructing the breast. Evidence of breast cancer cells was found in 10 percent of biopsies from the women with breast cancer and one patient undergoing preventive mastectomy. In these cases, the nipple was not used in breast reconstruction.

In the remaining patients, the biopsies showed no evidence of cancer, and the tissues were used for breast reconstruction. At an average follow-up of more than three years, there were no recurrent cancers of the nipple-areola complex in women undergoing therapeutic mastectomy, and no primary cancers in women undergoing preventive mastectomy. This supported previous findings that the long-term risk of cancer developing in the nipple and surrounding tissues after nipple-sparing mastectomy is "zero or near-zero," Dr. Spear and colleagues write.

Another common concern about nipple-sparing mastectomy is that it will lead to problems with blood flow (ischemia) to the nipple and areola after reconstruction. Ischemia was a significant complication in two percent of cases in the study; the authors believe that steps can be taken to minimize this risk.

Dr. Spear and colleagues emphasize that nipple-sparing mastectomy isn't right for all women with breast cancer: for example, women with large breasts or more advanced cancers. However, in appropriately selected cases, they believe that nipple-sparing mastectomy offers some important advantages.

Whether the procedure is being done for treatment or prevention of breast cancer, preserving the nipple and surrounding tissues for use in reconstruction can improve the outcomes of surgery without increasing the risk of later breast cancer. Dr. Spear and colleagues emphasize that biopsy of the underlying tissue "should be an integral part" of nipple-sparing mastectomy—especially when performed for breast cancer treatment.

Source: Plastic and Reconstructive Surgery