Oncological safety of therapeutic ‘nipple-sparing mastectomy’ followed by reconstruction: a systematic review

Abstract

Background

Breast cancer (BC) treatment traditionally consisted of radical and often mutilating surgery. Advances in the field of BC have led to new remedies, enabling the paradigm shift from radical to conservative surgery. New treatments such as nipple-sparing mastectomy (NSM) are becoming more popular, aiming to improve both oncological and aesthetic outcomes. However, evidence confirming the oncological safety of NSM is currently lacking, hindering its application. This systematic review sought to analyze NSM’s oncological safety as an alternative to conventional mastectomy (CM).

Patients and methods

A systematic review was performed, respecting the PRISMA guidelines. Pubmed, Embase, and Web of Science databases were consulted and searched for keywords: ‘nipple-sparing mastectomy’ and ‘mammaplasty’, or combinations of synonyms. Only original studies published between 2000 and 2020 reporting tumor recurrence and/or survival rates with a minimum of 5-year follow-up were included.

Results

From the 1675 unique records found, 14 studies were included, amounting to 5980 female BC patients who underwent NSM plus reconstruction. Included studies described either only ductal carcinoma in situ (DCIS, n = 1), only invasive BC (n = 3) or DCIS and invasive BC (n = 10). The most recurrent oncological metrics were 5-year local recurrence (0–10%), locoregional recurrence (0–7.4%), distant recurrence (1.6–15.6%), and overall survival rate (93.1–100%).

Conclusion

Based on long-term low BC recurrences and high survival rates, NSM is perceived to be non-inferior to CM from an oncological perspective. This identifies NSM plus reconstruction to be a safe curative treatment. Further studies should aim to elicit clear and applicable selection criteria in order to maximize NSM's potential.

Keywords:

• Nipple-sparing mastectomy
• NSM
• conventional mastectomy
• breast reconstruction
• nipple–areolar complex
• oncological safety

PROSPERO ID::

• CRD42021225184

Acknowledgment

The authors thank Prof. H. Wildiers (department of medical oncology, University Hospitals Leuven, Belgium) for his insights on the topic of breast cancer follow-up and survival.

Disclosure statement

The authors report no conflict of interest.