RESUMO
Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM. METHOD: All NSM procedures performed at our institution between 2014 and 2018 were reviewed. The tumor-to-nipple distance was measured for each patient using mammography, ultrasound, or magnetic resonance imaging. All patients underwent a frozen section (FS) biopsy of the base of the nipple during surgery, and if cancer was detected, the procedure was converted to a skin-sparing mastectomy. Patients were followed for postoperative complications and cancer recurrence. RESULTS: Sixty-eight patients (98 breasts) underwent NSM with immediate reconstruction. Fifty-three patients (78%) underwent the procedure for breast cancer. Nipple involvement was detected on FS in 1 patient and on permanent pathology after a negative FS in 1 patient. Forty-three percent of our patients had a tumor-to-nipple distance of ≤2 cm. During a mean follow-up of 32.5 months (±19.4 months), no locoregional recurrences were observed; however, distant metastasis occurred in 3 patients. CONCLUSIONS: When histologic examination from the base of the nipple is negative (either by FS or permanent pathology), NSM can be considered oncologically safe. Lack of nipple involvement by preoperative clinical and imaging assessment and intraoperative FS is sufficient to classify patients as suitable for NSM.
RESUMO
BACKGROUND: Neoadjuvant chemotherapy (NAC) before breast cancer surgery is safe and effective. By reducing the tumor burden, women can achieve complete resections with less extensive operations. Both surgeons and patients share concerns that NAC increases the risk for infection after immediate breast reconstruction, due to its effect on the immune system and the relatively short duration between chemotherapy and surgery. While breast reconstruction plays an increasingly significant role in the treatment of breast cancer, little has been written about the effect of NAC and its impact on post-operative complications. METHODS: We identified 158 patients (205 breasts) who underwent surgery for breast cancer with immediate reconstruction between the years 2013-2017 at the Kaplan Medical Center. Using univariate and multivariate statistics, we compared our patient characteristics according to our main predictor of interest: receiving NAC. We focused on the immediate post-operative complications: infection, skin necrosis, wound dehiscence, hematoma, seroma and implant explantation. RESULTS: Fifty-two patients received NAC and 106 did not. The neoadjuvant group was found to be younger (45 years old vs. 51, P<0.05). The overall complication rate was 30.3%, with a trend towards a lower complication rate in the NAC group, though not statistically significant (23% vs. 34% P=0.2). The overall infection rate was 8.8%, again with a trend towards a lower infection rate among the NAC group (3.8% vs. 11.3% P=0.12). Mastectomy (P=0.02), implant reconstruction (P=0.05) and diabetes (P<0.05) were associated with a higher complication rate. CONCLUSIONS: Our data indicates that NAC is not associated with an increased rate of immediate post-operative complications in women undergoing breast surgery and reconstruction. Therefore, receiving NAC should not be considered a reason to avoid immediate breast reconstruction.