Abstract P2-13-09: Is nipple-sparing mastectomy with implant reconstruction for breast cancer safe and worthwhile?
Authors: Regis C , Mesdag V , Tresch E , Chauvet MP , Boulanger L , Collinet P , Giard S 
Published: May 2016

Background: Nipple-sparing mastectomy (NSM) is a standard for bilateral prophylactic surgeries. However for cancer treatment, the preservation of the nipple areolar complex (NAC) is still discussed because of suspected increase of local recurrence and surgical specific complications as nipple or mastectomy flap necrosis. The aim of the study was to investigate both the relapse risk associated with NSM for breast cancer and women's satisfaction with preservation of the NAC.

Methods: We included retrospectively all patients who had skin-sparing mastectomy (SSM) or NSM from 2007 to 2012 for breast cancer or ductal carcinoma in situ (DCIS). We compared NSM and SSM group for oncological (overall survival (OS) and disease-free survival (DFS)) and surgical outcomes. Patients' satisfaction and quality of life has been evaluated by a specifically designed questionnaire, addressed by mail and inspired by the Breast-Q questionnaire with specific assessment of global esthetic result, harmony with the native breast and need for psychological support.

Results: During the study, we operated 5600 patients for a breast cancer, among them, 152 had NSM (n=63 / 41.5%) or SSM (n=89 / 58.5%) with immediate implant breast reconstruction. Eighty-nine (58.6%) patients had DCIS, and the other had invasive disease (86.9% of T1). The mastectomy has been indicated for primary cancer (81%) or recurrence (19%). The two groups did not differ significantly according to histological type (p=0.10), grade (p=0.84), hormonal receptor (p=0.7), HER2 (p=1.00), Ki67 (p=0.75) or node metastases (p=0.64). Median follow-up was 42 (IQR: 18-58 ) months. No cancer-related death occurred during the study. Local recurrence rate was 1.7% (n=1) in NSM group and 0% in SSM group (p=0.35). The recurrence did not appear on the preserved nipple. Severe complication requiring surgery (Grade 3 of Clavien-Dindo classification) occurred in 9.9% of the cases. In the NSM group, one patient had complete NAC necrosis and three patients suffered partial necrosis. Severe skin-flap necrosis leading to implant removal was more frequent in the SSM group (SSM: 6.7% (n=6) ; NSM: 0% (n=0); p=0.042). One hundred and four (80%) patients answered the questionnaire. Satisfaction about the aspect of the NAC was higher in the NSM group compared to SSM with delayed reconstruction of the nipple (75% vs 59%, p=0.14). Patients with NSM needed less psychological support before (p=0.028) and immediately after surgery (p=0.14) than patients in the SSM group, which may suggest a better acceptation of the surgery in this group.

Conclusion: NSM for breast cancer surgery was not associated with significant increase of local recurrence rate or surgical complications. Patient's satisfaction was high. Therefore, nipple-sparing mastectomy with immediate implant reconstruction can successfully and safely be performed for pre-invasive and small invasive breast cancer. Besides esthetic aspects, preserving the nipple may ease the acceptation of these radical surgeries.

Citation Format: Regis C, Mesdag V, Tresch E, Chauvet MP, Boulanger L, Collinet P, Giard S. Is nipple-sparing mastectomy with implant reconstruction for breast cancer safe and worthwhile?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-13-09.