Less Invasive Mastectomy an Option for More Patients

Complication rates for nipple-sparing mastectomy (NSM) are decreasing despite expanded indications for the procedure among higher-risk patients, according to a study presented at the annual meeting of the American Society of Breast Surgeons, held.

Whitney Young, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined complication and reconstruction success rates among patients treated in 2009 to 2017 with NSM identified from an institutional, prospective breast surgery registry. Analysis included 1,301 breasts in 769 women undergoing NSM for cancer or risk reduction (median age, 48 years).

The researchers found that the overall 30-day complication rate was 7.5 percent but declined from 14.8 percent in 2009 to 6.3 percent in 2017. During the same time period, the proportion of patients with obesity and treated with neoadjuvant chemotherapy increased. There was a significant increase in 30-day complication rates among patients with prior radiation (odds ratio, 2.3) and recent/current smoking (odds ratio, 3.3). At one year, reconstruction success was 98.5 percent. One-year reconstruction failure was significantly associated with previous radiation (odds ratio, 4.6) and postoperative adjuvant radiation (odds ratio, 3.3).

"These data confirm a team learning curve with NSM and also demonstrate the nipple-sparing approach is suitable for appropriately selected higher-risk patients for both risk reduction and cancer treatment," the authors write.

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