Mastectomies that preserve the nipple and an envelope of breast skin are as safe as more radical operations for qualifying early-stage breast cancer patients, according to a meta-analysis and systematic literature review presented at the American Society of Breast Surgeons 16th Annual Meeting.¹

Data from the Surveillance, Epidemiology, and End Results (SEER) registry have shown that the rate of nipple-sparing mastectomy has increased 202% since 2005, but “oncological safety has been a concern, due to the potential for residual glandular breast tissue to harbor future cancer,” said lead author Lucy De La Cruz, MD, of the University of Miami, Florida.

The incidence of occult malignancy in the nipple-areolar complex ranges from 0% to 53%, with an average of 11.5%, she said. Generally, however, studies have suggested that nipple-sparing mastectomy is as safe and effective in preventing cancer recurrence as more radical procedures, Dr. De La Cruz indicated.

Study Details

Dr. De La Cruz and colleagues evaluated the safety and efficacy of nipple-sparing mastectomy by conducting a systematic literature review and meta-analysis of 19 studies published between 2004 and 2015 involving 5,393 patients, of whom 2,013 received nipple-sparing mastectomy. Some studies compared nipple-sparing mastectomy with skin-sparing mastectomy and modified radical mastectomy, whereas others were single-arm nipple-sparing mastectomy studies. Studies followed patients ranging from 10 to 156 months.

Comparison of Surgical Techniques

In the comparison-arm studies, 29.9% of women underwent nipple-sparing mastectomy, 15% had skin-sparing mastectomy, and 55.1% had modified radical mastectomy. In the 19 studies combined, overall survival was 96% for nipple-sparing mastectomy, and the disease-free survival rate was 93.6%. The rate of nipple-areolar recurrence was 1.2% overall with nipple-sparing mastectomy.

Compared with other surgical techniques, overall survival was found to be 2.5% greater among the nipple-sparing mastectomy cohorts, and disease-free survival was 4.4% greater, both statistically significant. When we looked at local recurrence, there was no difference between the groups.

“Nipple-sparing mastectomy was found to be at least as safe as more radical surgeries, judged on both overall survival and disease-free survival,” Dr. De La Cruz reported.

They also compared nipple-sparing mastectomy outcomes between women having nipple-sparing mastectomy for therapeutic mastectomy alone and for either therapeutic or prophylactic purposes (ie, combined group). In this comparison, overall survival was 93.0% for the therapeutic nipple-sparing mastectomy group vs 99.0% for the combined group (P = .006); disease-free survival was 84.2% vs 96.2% (P = .012); and nipple-areolar recurrence was 2.6% vs 0.4% (P = .001). The better results in the combined group were not surprising, since many of these women did not have cancer, she pointed out.

“Our conclusion is that nipple-sparing mastectomy is oncologically safe in carefully selected women with early-stage breast cancer,” Dr. De La Cruz said, “but our data need validation from other sources, including the use of prospective data registries, most notably the Nipple-Sparing Mastectomy ­Registry.” ■

Disclosure: Dr. De La Cruz reported no potential conflicts of interest.

Reference

1. De La Cruz LM, Blankenship S, Tappy, E et al: Overall survival, disease-free survival, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: A meta-analysis. 2015 American Society of Breast Surgeons Annual Meeting. Presented April 30, 2015.