AESTHETIC OUTCOME AND ONCOLOGICAL SAFETY OF NIPPLE-SPARING MASTECTOMY
Keywords:
breast neoplasms, esthetics, subcutaneous mastectomy, treatment outcomeAbstract
Background: Nipple-sparing mastectomy (NSM) has been performed for breast cancer treatment and for women at high risk. NSM provides better aesthetic outcomes; however, its oncological safety is still controversial. Objective: To evaluate the surgical complications, oncological safety and aesthetic satisfaction of breast cancer patients undergoing NSM with immediate breast reconstruction operated by the same medical team in a Breast Cancer Center in Brazil. Method: From 2004 to 2011, an aesthetic satisfaction questionnaire was administered to women undergoing NSM followed by immediate breast reconstruction 30 or 60 days after surgery. Aesthetic satisfaction, complication rates and oncological safety were analyzed. Results: Thirty-six breast cancer patients who underwent NSMs followed by immediate reconstruction answered the questionnaire. Most of them considered their results good (51%) or great (43%) and all patients will recommend NSM as a therapeutic treatment for other women with breast cancer. Only one patient presented infection and loss of the mammary implant, and recurrence rates were satisfactory (5.5%). Conclusion: Our findings showed low complication rate, oncological safety and good aesthetic outcome related to NSM with immediate reconstruction in patients from a Breast Cancer Center in Brazil. Despite the limitations of our study, we support the use of NSM with immediate reconstruction for a better aesthetic outcome with oncological safety.
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Dull B, Conant L, Myckaty T, Tenenbaum M, Cyr A, Margenthaler JA. Nipple-sparing mastectomies: Clinical outcomes from a single academic institution. Mol Clin Oncol. 2017;6(5):737-42. https://doi.org/10.3892/mco.2017.1208
Smith BL, Tang R, Rai U, Plichta JK, Colwell AS, Gadd MA, et al. Oncologic Safety of Nipple-Sparing Mastectomy in Women with Breast Cancer. J Am Coll Surg. 2017;225(3):361-5. https://doi.org/10.1016/j.jamcollsurg.2017.06.013
Hieken TJ, Boolbol SK, Dietz JR. Nipple-Sparing Mastectomy: Indications, Contraindications, Risks, Benefits, and Techniques. Ann Surg Oncol. 2016;23(10):3138-44. https://doi.org/10.1245/s10434-016-5370-5
Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple–areola complex and autologous reconstruction: an extended follow-up study. Ann Surg Oncol. 2009;249(3):461-8. https://doi.org/10.1097/SLA.0b013e31819a044f
Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, et al. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol. 2013;30(1):481. https://doi.org/10.1007/s12032-013-0481-3
De La Cruz L, Moody AM, Tappy EE, Blankenship AS, Hecht EM. Overall survival, disease-free survival, local recurrence and nippleareolar recurrence in the setting of nipple-sparing mastectomy: A meta-analysis and systematic review. Ann Surg Oncol. 2015;22(10):3241-9. https://doi.org/10.1245/s10434-015-4739-1
Razdan SN, Patel V, Jewell S, McCarthy CM. Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes. Qual Life Res. 2016;25(6):1409-21. https://doi.org/10.1007/s11136-015-1181-6
Howard MA, Sisco M, Yao K, Winchester DJ, Barrera E, Warner J, et al. Patient satisfaction with nipple-sparing mastectomy: A prospective study of patient reported outcomes using the BREAST-Q. J Surg Oncol. 2016;114(4):416-22. https://doi.org/10.1002/jso.24364
Bailey CR, Ogbuagu O, Baltodano PA, Simjee UF, Manahan MA, Cooney DS, et al. Quality-of-Life Outcomes Improve with Nipple- Sparing Mastectomy and Breast Reconstruction. Plast Reconstr Surg. 2017;140(2):219-26. https://doi.org/10.1097/PRS.0000000000003505
Rojas K, Onstad M, Raker C, Clark MA, Stuckey A, Gass J. The impact of mastectomy type on the Female Sexual Function Index (FSFI), satisfaction with appearance, and the reconstructed breast’s role in intimacy. Breast Cancer Res Treat. 2017;163(2):273-9. https://doi.org/10.1007/s10549-017-4174-z
Salhab M, Sarakbi WA, Joseph A, Sheards S, Travers J, Mokbel K. Skin-sparing mastectomy with immediate breast reconstruction: patient satisfaction and clinical outcome. Int J Clin Oncol. 2006;11(1):51-4.
Pesce C, Liederbach E, Wang C, Lapin B, Winchester DJ, Yao K. Contralateral prophylactic mastectomy provides no survival benefit in young women with estrogen receptor-negative breast cancer. Ann Surg Oncol. 2014;21(10):3231-9. https://doi.org/10.1245/s10434-014-3956-3
Wong SM, Freedman RA, Sagara Y, Aydogan F, Barry WT, Golshan M. Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Ann Surg. 2017;265(3):581-9. https://doi.org/10.1097/SLA.0000000000001698
Wright FC, Look Hong NJ, Quan ML, Beyfuss K, Temple S, Covelli A, et al. Indications for Contralateral Prophylactic Mastectomy: A Consensus Statement Using Modified Delphi Methodology. Ann Surg. 2018;267(2):271-9. https://doi.org/10.1097/SLA.0000000000002309
Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods JE, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23(31):7849-56. https://doi.org/10.1200/JCO.2005.09.233
Geiger AM, West CN, Nekhlyudov L, Herrinton LJ, Liu IL, Altschuler A, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24(9):1350-6. https://doi.org/10.1200/JCO.2005.01.9901
Soran A, Ibrahim A, Kanbour M, McGuire K, Balci FL, Polat AK, et al. Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer. Am J Clin Oncol. 2015;38(2):179-83. https://doi.org/10.1097/COC.0b013e318292f8a7
Longo B, Laporta R, Sorotos M, Pagnoni M, Gentilucci M, Santaneli di Pompeo F. Total breast reconstruction using autologous fat grafting following nipple-sparing mastectomy in irradiated and non-irradiated patients. Aesthetic Plast Surg. 2014;38(6):1101-8. https://doi.org/10.1007/s00266-014-0406-3
Spear SL, Shuck J, Hannan L, Albino F, Patel KM. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg. 2014;133(5):605e-14e. https://doi.org/10.1097/PRS.0000000000000098
Reefy S, Patani N, Anderson A, Burgoyne G, Osman H, Mokbel K. Oncological outcome and patient satisfaction with skinsparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer. 2010;10:171. https://dx.doi.org/10.1186%2F1471-2407-10-171
Manning AT, Sacchini VS. Conservative mastectomies for breast cancer and risk-reducing surgery: the Memorial Sloan Kettering Cancer Center experience. Gland Surg. 2016;5(1):55- 62. https://doi.org/10.3978/j.issn.2227-684X.2015.10.02
Headon HL, Kasem A, Mokbel K. The oncological safety of nipple-sparing mastectomy: a systematic review of the literature with a pooled analysis of 12,358 procedures. Arch Plast Surg. 2016;43(4):328-38. https://doi.org/10.5999/aps.2016.43.4.328
Orzalesi L, Casella D, Santi C, Cecconi L, Murgo R, Rinaldi S, et al. Nipple sparing mastectomy: Surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period. Breast. 2016;25:75- 81. https://doi.org/10.1016/j.breast.2015.10.010
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Copyright (c) 2019 Janaina Ferreira Viegas, Martina Lichtenfels, Alessandra Borba Anton de Souza, Betina Vollbrecht, Francisco Laitano Neto, Felipe Pereira Zerwes, Antônio Luiz Frasson
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