Abstract: Examining Oncologic Outcomes after Nipple-Sparing Mastectomy: A Single-Institutional Experience (Plastic Surgery 2015)

Sunday, October 18, 2015: 11:00 AM

Jordan D Frey, MD , Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY

Michael Alperovich, MD , Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY

Jennifer Chun Kim, MPH , Department of Surgery, NYU Medical Center, New York, NY

Pierre B. Saadeh, MD , Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY

Alexes Hazen, MD , Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY

Jamie P Levine, MD , Institute of Reconstructive Plastic Surgery, New York University, New York, NY

Christina Y Ahn, MD , Plastic Surgery, NYU Langone Medical Center, New York, NY

Robert Allen, MD , Institute of Reconstructive Plastic Surgery, New York University, New York, NY

Mihye Choi, MD , Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY

Freya R Schnabel, MD , Department of Surgery, NYU Medical Center, New York, NY

Nolan S. Karp, MD , Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY

Amber A Guth, MD , Surgery, New York University, New York, NY

Presentation PDF file

Examining Oncologic Outcomes after Nipple-Sparing Mastectomy: A Single-Institutional Experience

Introduction:

Long-term oncologic outcomes in nipple-sparing mastectomy (NSM) continue to be defined. Rates of locoregional recurrence for skin-sparing mastectomy (SSM) and NSM in the literature range from 0 to 11.7%. We investigated the outcomes of NSM at our institution.

Methods:

Patients undergoing NSM at our institution from 2006 to 2014 were identified. Patient demographics, tumor characteristics, and outcomes were collected. Locoregional recurrence was compared to published NSM and SSM results compiled from 14 and 11 studies.

Results:

From 2006 to 2014, 319 patients (555 breasts) underwent NSM. 149 patients had long-term follow-up available. Patient demographics and tumor characteristics are demonstrated in Table 1. Average patient follow-up was 30.72 months. There was one (0.7%) incidence of ipsilateral chest-wall recurrence in a 44 year-old (p<0.0001, compared to aggregate NSM and SSM data). There were 0.36 complications per patient (Table 2).

Conclusions:

We find a locoregional recurrence rate of 0.7% in NSM with no nipple-areolar complex recurrence. This rate is significantly lower than aggregate published rates for both NSM and SSM.

Tables:

Table 1: Patient Demographics and Tumor Characteristics

Age (years)

47.7

Race

Caucasian: 127 (85.2%)
Non-Caucasian: 22 (14.8%)

BMI

24.28

Tobacco History

7 (4.7%)

Radiation History

8 (5.4%)

BRCA 1/2 Status

10 (6.7%)

Unilateral vs. Bilateral NSM

Unilateral: 76 (51.0%)
Bilateral: 73 (49.0%)

Indication for Mastectomy

Therapeutic: 126 (84.6%)
Prophylactic: 23 (15.4%)

Neoadjuvant Therapy

6 (4.0%)

Follow-Up (months) (Range)

30.72 (57.6-8.28)

Tumor Size (cm)

1.41

Histologic Type (Percent of Therapeutic NSM)

IDC: 82 (66.7%)
DCIS: 30 (23.8%)
ILC: 7 (5.6%)
Invasive Other: 6 (4.8%)
Mixed Type: 1 (0.8%)

Pathologic Stage

Stage 0: 52 (34.9%)
Stage I: 54 (36.2%)
Stage IIA: 14 (9.4%)
Stage IIB: 8 (5.4%)
Stage IIIA: 3 (2.0%)
Stage IIIC: 1 (0.7%)

Positive Nodal Status

22 (14.8%)

Table 2: NSM Complications per Patient

Positive Subareolar Biopsies

Frozen Section: 6 (7 breasts) (4.0%)
Permanent Section: 2 (1.3%)

Mastectomy Flap Necrosis

12 (8.1%)

Nipple-Areola Complex Necrosis

Partial-Thickness: 2 (1.3%)
Full-Thickness: 1 (0.67%)

Implant Extrusion

4 (2.7%)

Cellulitis

Oral Antibiotics: 12 (8.1%)
Intravenous Antibiotics: 2 (1.3%)

Hematoma

4 (2.7%)

Seroma

3 (2.0%)

Wound Dehiscence

1 (0.67%)

Capsular Contracture

2 (1.3%)

Microvascular Free Flap Failure

1 (0.67%)

Positive Subareolar Biopsies	Frozen Section: 6 (7 breasts) (4.0%) Permanent Section: 2 (1.3%)
Mastectomy Flap Necrosis	12 (8.1%)
Nipple-Areola Complex Necrosis	Partial-Thickness: 2 (1.3%) Full-Thickness: 1 (0.67%)
Implant Extrusion	4 (2.7%)
Cellulitis	Oral Antibiotics: 12 (8.1%) Intravenous Antibiotics: 2 (1.3%)
Hematoma	4 (2.7%)
Seroma	3 (2.0%)
Wound Dehiscence	1 (0.67%)
Capsular Contracture	2 (1.3%)
Microvascular Free Flap Failure	1 (0.67%)

27089 Examining Oncologic Outcomes after Nipple-Sparing Mastectomy: A Single-Institutional Experience