J Breast Cancer.  2010 Mar;13(1):65-73. 10.4048/jbc.2010.13.1.65.

The Oncologic Safety of Skin Sparing Mastectomy with or without Conservation of the Nipple-areolar Complex: 5 Years Follow up Results

• Jeon YS
• Kang SH
• Bae YK
• Lee SJ

• KMID: 2286562
• DOI: http://doi.org/10.4048/jbc.2010.13.1.65

Abstract

PURPOSE
Little is known about long term results of nipple-areola preserving skin-sparing mastectomy (NASSM), and there are no such reports on this from South Korea. We studied 5 years follow up results of NASSM and skin sparing mastectomy (SSM) and compared clinical outcomes between NASSM and SSM.
METHODS
Two hundred two patients who underwent SSM (69 patients) or NASSM (133 patients) from September 1996 to December 2006 were included. Frozen section analysis of retroareolar resection margin was done to make the decision on preserving or not preserving nipple-areolar complex (NAC). In the case of positive result on the frozen section, NAC was sacrificed. The local relapse (LR) rate and local relapse free survival (LFS) were analyzed for comparing between NASSM and SSM.
RESULTS
The mean age was 40.2 years (range, 24-65), the mean follow-up was 67.6 months. 52 NACs (25.7%) were involved by tumor cells. The invasion to the NAC by tumor cell was more common for invasive carcinoma with extensive intraductal component (p<0.001), central located tumor (p=0.025) and invasive carcinoma with multiplicity (p=0.001). There were 12 cases (9.0%) of local relapse in NASSM group and 4 (5.8%) in SSM group, but there was no significant correlation for the LR rate (p>0.05). Regional or distant recurrence after surgical treatment for local relapse occurred in only one SSM case. Five years LFS rate of the NASSM group was 92.1% and that of the SSM group was 95.2%. There was no significant difference for the LFS (p>0.05).
CONCLUSION
Our long term follow up study showed that NASSM and SSM are much alike for their LR rate and LFS. Even if relapse occurs in the NAC, this recurrence cannot affect the progression of relapse after adequate local treatment. Thus, NASSM is alternative method for SSM with oncological safety and better cosmetic outcome.

Keyword

Breast; Carcinoma; Mastectomy; Nipples; Prognosis

MeSH Terms

Breast
Cosmetics
Follow-Up Studies
Frozen Sections
Humans
Mastectomy
Nipples
Prognosis
Recurrence
Republic of Korea
Skin
Cosmetics

Figure

• 

  Figure 1 Dissection line of mastectomy and frozen section analysis of nipple-areolar resection margin. (A) A flap of subcutaneous adipose tissue (more than 1 cm thickness) was created and nipple-areolar resection margin was inked by blue ink and then, blue inked resection margin was sliced in 2-3 mm interval with perpendicularly 5 mm thickness.(B) In (C) case, the distance from resection margin to tumor cells was 3 mm. So, nipple-areolar complex could be preserved. But, if the distance was less than 2 mm (D), nipple-areolar complex was removed (C, D, H&E stain, ×10).

• 

  Figure 2 Local relapse free survival curves of breast cancer patients operated by NASSM vs. SSM. The curve shows that there was no significant difference in the survivals. NASSM=nipple areola preserving skin sparing mastectomy; SSM=skin sparing mastectomy.

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