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Breast. 2015 Oct;24(5):661-6. doi: 10.1016/j.breast.2015.08.001. Epub 2015 Sep 3.

Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy.

Author information

1
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
2
Breast Center - Division of Pathology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
3
Breast Center - Division of Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
4
Breast Center - Division of Radiology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
5
Breast Center - Division of Radiation Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
6
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy. Electronic address: lfortunato@hsangiovanni.roma.it.

Abstract

BACKGROUND:

Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH).

PATIENTS AND METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Breast cancer; Mastectomy; Neoadjuvant chemotherapy; Nipple sparing mastectomy

PMID:
26343944
DOI:
10.1016/j.breast.2015.08.001
[Indexed for MEDLINE]

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