Minimal access nipple-sparing mastectomy a viable breast cancer treatment option

Minimal access nipple-sparing mastectomy (M-NSM) compares favourably with conventional nipple-sparing mastectomy (C-NSM), with similar complication rates indicating that the two approaches are equally safe, according to a study.

The retrospective multicentre cohort from Korea included 1,583 female patients with breast cancer who underwent nipple-sparing mastectomy. Exclusion criteria included mastectomy without preserving the nipple-areolar complex, clinical or pathological malignancy in the nipple-areolar complex, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, and insufficient medical records.

Of the patients, 1,356 underwent C-NSM (mean age 45.47 years) and 227 undergoing M-NSM (mean age 45.41 years, 35 endoscopy-assisted and 192 robot-assisted). The main outcomes were clinicopathological factors and postoperative complications within 3 months of surgery.

Postoperative complications between the C-NSM group and the M-NSM group did not significantly differ in the short term (<30 days: 34.29 percent vs 32.16 percent; p=0.53) as well as in the long term (<90 days: 38.72 percent vs 32.16 percent; p=0.06).

The C-NSM group had a higher incidence of nipple-areolar complex necrosis in the long term (6.71 percent vs 2.20 percent; p=0.04) and postoperative seroma (14.23 percent vs 9.25 percent; p=0.04) but a lower incidence of wound infection (4.28 percent vs 7.93 percent; p=0.03).

Mild or severe breast ptosis was significantly associated with greater odds of nipple necrosis (odds ratio [OR], 4.75, 95 percent confidence interval [CI], 1.66–13.60; p=0.004) or areolar necrosis (OR, 8.78, 95 percent CI, 1.88-41.02; p=0.006). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with lower odds of necrosis (other incisions: OR, 32.72, 95 percent CI, 2.11–508.36; p=0.01). The odds of necrosis were low following a direct-to-implant breast reconstruction vs other breast reconstructions (OR, 2.85, 95 percent CI, 1.11–7.34; p=0.03).