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In Appropriate Women, Nipple-Sparing Mastectomy Doesn’t Lead to Higher Breast Cancer Recurrence Rates

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Rates of breast cancer recurrence (the cancer coming back) in the nipple/areola area after nipple-sparing mastectomy with immediate reconstruction were low as long as the characteristics of the breast cancer were considered when deciding who should have the procedure, according to a study.

The research was published online on Aug. 28, 2019. Read the abstract of “Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer.”

What is immediate reconstruction?

Many, but not all, women who have mastectomy to treat breast cancer go on to have one or both breasts reconstructed. There are many ways to reconstruct a breast. Tissue from the back, belly, buttocks, or other part of the body can be used to create a new breast. Doctors call this autologous reconstruction. Saline or silicone implants are another option. In some cases, an implant is added after autologous reconstruction.

Breast reconstruction can be done at different times, depending on what works best for your unique situation and diagnosis. Immediate reconstruction means that breast reconstruction is done at the same time as mastectomy surgery. As soon as the breast is removed by the breast cancer surgeon, the plastic surgeon reconstructs the breast. Nearly all the work is done during one operation, and you wake up with a rebuilt breast (or breasts).

What is nipple-sparing mastectomy?

Nipple-sparing mastectomy leaves the nipple and areola intact, along with the breast skin. All the breast tissue underneath the nipple, areola, and breast skin is removed. The tissue beneath the nipple and areola are checked for cancer. If cancer is detected, the nipple and areola are then removed.

Nipple-sparing mastectomy followed by immediate reconstruction is becoming more popular because it provides very good cosmetic results. Still, because nipple-sparing mastectomy is a relatively new type of breast cancer surgery, not much research has focused on long-term outcomes, including recurrence rates after the procedure.

Oncologists worry that if one or two breast cancer cells are in the nipple or areola tissue, the cancer could recur.

In the United States, women diagnosed with breast cancer with the following characteristics are not candidates for nipple-sparing mastectomy:

  • the cancer is multifocal, which means there are multiple tumors in the same quadrant of the breast
  • the cancer is multicentric, which means there are tumors in several quadrants of the breast
  • there are large areas of DCIS in addition to invasive cancer tumors
  • the cancer tumor is bigger than 3 centimeters (cm)
  • the cancer tumor is less than 2 cm away from the nipple/areola tissue

How this study was done

This South Korean study focused on breast cancer recurrence rates in the nipple/areola area after nipple-sparing mastectomy, as well as the risk factors linked to recurrence in that area.

The study included 944 women who had nipple-sparing mastectomy and immediate reconstruction on 962 breasts. All the women were diagnosed with early-stage breast cancer between March 2003 and December 2015. None of the women had chemotherapy or hormonal therapy after surgery. About 80% of the women were younger than 50 and 20% were 50 or older.

The characteristics of the breast cancers:

  • 52.9% were multifocal or multicentric
  • 68.3% had zero positive lymph nodes, 24.3% had one to three positive lymph nodes, and 7.4% had four or more positive lymph nodes
  • 60.7% of the cancers were more than 1 cm away from the nipple/areola tissue, and 37.8% were 1 cm or closer to the nipple/areola tissue
  • 63.0% were hormone-receptor-positive and HER2-negative, 15.8% were hormone-receptor-negative and HER2-positive, 12.8% were hormone-receptor-positive and HER2-positive, and 8.4% were triple-negative
  • 60.2% had large areas of DCIS in addition to the invasive cancer

After surgery, the women had follow-up visits with their doctors every 3 to 6 months for the first 5 years, then every year after that. Follow-up time ranged from 14 months to 15.4 years. Half the women were followed for more than 7 years and half were followed for shorter periods of time.

During follow-up, 39 cancer recurrences in the nipple/areola area were diagnosed. This is a recurrence rate of 4.1%. This did not include any recurrences in other areas of the breast or areas away from the breast.

The women who were diagnosed with a breast cancer recurrence in the nipple/areola area ranged in age from 26 to 54. The sizes of the original breast cancers ranged from 0.5 cm to 12.0 cm.

The researchers found that certain characteristics of the original breast cancer were linked to the likelihood of cancer recurrence in the nipple/areola area, including:

  • multifocal
  • multicentric
  • hormone-receptor-negative and HER2-positive
  • high grade
  • large areas of DCIS in addition to the invasive cancer

What this means for you

This study gives women and their doctors more information on long-term outcomes after nipple-sparing mastectomy. It also underscores that candidates for nipple-sparing mastectomy must be selected carefully.

If you’ve been diagnosed with early-stage breast cancer and have decided to have reconstruction after mastectomy, you and your surgeon may be discussing nipple-sparing mastectomy with immediate reconstruction.

Keeping your nipple and areola may be very important to you, and you may like the idea of waking up after immediate reconstruction with a rebuilt breast.

Because nipple-sparing mastectomy isn’t for everyone, it makes sense to talk to your doctor about the characteristics of the cancer. If the cancer:

  • is multifocal
  • is multicentric
  • has large amounts of DCIS in addition to the invasive cancer
  • is larger than 3 cm
  • is closer than 2 cm to the areola area

you are not a good candidate for nipple-sparing mastectomy.

For more information, visit the pages on Nipple-Sparing Mastectomy and When Is Breast Reconstruction Done?

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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