J Breast Cancer.  2019 Dec;22(4):613-623. 10.4048/jbc.2019.22.e48.

Oncologic Outcomes of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Patients with Tumor–Nipple Distance Less than 2.0 cm

• Alsharif E
• Ryu JM
• Choi HJ
• Nam SJ
• Kim SW
• Yu J
• Chae BJ
• Lee SK
• Lee JE

• KMID: 2470897
• DOI: http://doi.org/10.4048/jbc.2019.22.e48

Abstract

PURPOSE
Although the indications for nipple-sparing mastectomy (NSM) are expanding, there remains a debate regarding the oncologic outcomes of patients treated with this method, especially those with a short tumor-nipple distance (STND). The aim of this study was to compare the long-term oncologic outcomes between patients with a long tumor-nipple distance (LTND) (≥ 2.0 cm) and those with STND (< 2.0 cm).
METHODS
This was a retrospective study in which 266 patients who underwent NSM with immediate breast reconstruction between January 2008 and December 2014 at a single institution were enrolled. Of these patients, 21 were excluded because of loss to follow-up; thus, 245 patients were finally analyzed. All patients underwent preoperative breast magnetic resonance imaging and intraoperative frozen biopsy.
RESULTS
The mean age of the patients was 42.4 years. STND was identified in 128 patients, and LTND in 117 patients. The mean follow-up period was 60.5 months. There were no significant differences between the 2 groups with respect to lymphovascular invasion, nuclear grade, nodal status, and subtype (p = 0.339, 0.372, 0.955, and 0.338, respectively). The STND group had significantly smaller tumors than the LTND group (p = 0.005). The median TND in the STND and LTND groups was 0.7 cm and 3.0 cm, respectively. Locoregional recurrence was reported in 4 patients in the STND group (3.1%) and 6 (5.1%) in the LTND group. A total of 3 patients died (1.2%; 2 in the STND group and one in the LTND group). There was no significant difference between the 2 groups with respect to disease-free survival or local recurrence-free survival (p = 0.334 and p = 0.477, respectively).
CONCLUSION
The long-term oncologic outcomes of patients treated with NSM did not significantly differ according to TND when the intraoperative frozen biopsy was negative for tumor cells.

Keyword

Breast neoplasms; Prognosis; Subcutaneous mastectomy

MeSH Terms

Biopsy
Breast Neoplasms
Breast*
Disease-Free Survival
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Mammaplasty*
Mastectomy*
Mastectomy, Subcutaneous
Methods
Prognosis
Recurrence
Retrospective Studies

Figure

• 

  Figure 1 The annual proportions of patients in the LTND and STND groups. LTND = long tumor–nipple distance; STND = short tumor–nipple distance.

• 

  Figure 2 Kaplan-Meier analysis of DFS and LRFS in the STND and LTND groups. DFS = disease-free survival; LRFS = local recurrence-free survival; STND = short tumor–nipple distance; LTND = long tumor–nipple distance.

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  Figure 3 Kaplan-Meier analysis of DFS and LRFS in the STND and LTND stratified by ductal carcinoma in situ (A, B) and invasive cancer (C, D). DFS = disease-free survival; LRFS = local recurrence-free survival; STND = short tumor–nipple distance; LTND = long tumor–nipple distance.

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