Applicability of the nipple-areola complex-sparing mastectomy - A prediction model using mammography to estimate risk of nipple-areola complex involvement in breast cancer patients

Rhode Island Hospital, Providence, Rhode Island, United States
Annals of Plastic Surgery (Impact Factor: 1.46). 06/2006; 56(5):498-504; discussion 504. DOI: 10.1097/
Source: PubMed

ABSTRACT The purpose of this study was to develop a prediction model that can be used to identify breast cancer patients at lowest risk for neoplastic nipple-areola complex (NAC) involvement to offer total NAC-sparing mastectomy with immediate reconstruction. Medical records, pathology slides, and mammograms were reviewed for all breast cancer patients treated with total mastectomy at Rhode Island Hospital between 2000 and 2004. The distance between the nipple and the closest tumor margin was measured using mammography. NAC involvement was identified in 42% of the 31 study patients. Mammographic distance, pathologic stage, and tumor size were identified as independent predictors of malignant NAC involvement by multivariate analysis (rho < 0.05). Based on these predictors, a linear discriminant score, the NAC Involvement Score (NACIS), was computed to distinguish between the presence and absence of NAC involvement. For individual patients, positive NACIS values (> or = -0.3665) were associated with NAC involvement with a sensitivity of 92%, specificity of 77%, and negative predictive value of 93%. These preliminary findings indicate that the NACIS formula may be a useful clinical tool for selecting low-risk patients for total NAC-sparing mastectomy with immediate reconstruction.

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    ABSTRACT: Background. Skin and nipple areola sparing mastectomy (NASM) has recently gained popularity as the management of breast cancer. This study aims to evaluate the aesthetic outcome, patient satisfaction, and oncological safety of NASM. Methods. The study prospectively analyzes the results of NASM and immediate breast reconstruction in 34 women with breast cancer. The criteria for inclusion were core biopsy-proven, peripherally located breast cancer of any tumor size and with any "N" status, with documented negative intraoperative frozen section biopsy of retroareolar tissue, and distance from the nipple to tumor margin >2 cm on mammography. Results. The median age of the patients was 45 years. The majority had either stage II or stage III breast cancer. The median mammographic distance of tumor from nipple areola complex (NAC) was 3.8 cm. The overall operative morbidity was minimal. The NAC could be preserved in all the patients. There was no local recurrence of tumor at median follow-up of 28.5 months. The aesthetic outcomes were satisfactory. Conclusion. NASM and immediate breast reconstruction can be successfully achieved with minimal morbidity and very low risk of local recurrence in appropriately selected breast cancer patients, with acceptable aesthetic results and good patient satisfaction.
    01/2014; 2014:589068. DOI:10.1155/2014/589068
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    ABSTRACT: Breast cancer is the most common cancer among women.Positive family history, genetic mutation or ductal changes increase the risk of breast cancer. Prophylactic mastectomy is the most e!ective treatment to avoid the breast cancer. After prophylactic mastectomy, most appropriate treatment is the immediate reconstruction. Immediate reconstruction prevents secondary trauma and body image disorder. The most common reconstructive technique in our clinic after prophylactic mastectomy is reconstruction with autogenous tissues. Autogenous reconstructions will serve softer and natural looking breast and su!er less deformations within time and radiotherapy. Between 2001 and 2008, 21 patients were treated with bilateral breast reconstruction, 18 of which underwent prophylactic mastectomy. All mastectomies were subcutaneous mastectomies including nipple areola complex. Eighteen patients were treated with free tissue transfer, whereas three were pedicled. The most preferred free tissue transfer was deep inferior epigastric artery perforator Total success rate was 95.2% (40/42). Two "aps were lost due to vascular complications (4.8%). Minor complications were seen in 14 %of patients including umbilicus necrosis, abdominal flap necrosis, mastectomy flap necrosis, abdominal laxity. For better symmetry secondary revisions like fat grafting, scar revisions, silicone implants were done in five patients. Reconstruction of nipple areola complex was completed in ten patients.In conclusion, as the risks groups of breast cancer is well understood, prophylactic mastectomy indications increase. As the immediate reconstruction with autogenous tissues reduces the body image disorder and additional trauma; it is the most common treatment option after prophylactic mastectomy in our clinic.
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    ABSTRACT: Purpose The oncological safety of nipple-sparing mastectomy in the context of immediate breast reconstruction is debatable. Previous studies report wide variations in local recurrence rates and randomised or matched cohort study designs are lacking. The aim of this study is to compare the local recurrence rate after nipple-sparing mastectomy to that after conventional mastectomy. Further, to compare the disease-free, overall and breast cancer-specific survival rates. Methods A retrospective review of all patients undergoing nipple-sparing mastectomy with immediate implant-based breast reconstruction at Karolinska University Hospital, Sweden, in the years 2000-2012 was conducted. These were matched 1:3 to patients operated by conventional mastectomy. Matching variables were age, tumour stage and year of surgery. Results Sixty-nine nipple-sparing mastectomies in 67 patients (study group) and 206 conventional mastectomies in 203 patients (control group) were included in the study. Median follow-up was 36 and 35 months for the study and control group, respectively. No local recurrence occurred in the study group, while seven local recurrences were observed in the control group (p=0.197). The estimated 5-year figures were 100% and 95.8% (local recurrence-free survival), 94.1% and 82.5% (disease-free survival), 96.2% and 91.3% (overall survival) and 98.0% versus 94.8% (breast cancer-specific survival). Survival rates did not differ significantly between groups. Conclusions Nipple-sparing mastectomy may be offered to selected breast cancer patients without any negative impact on oncological safety.
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