Is Nipple/Skin-Sparing Mastectomy with Immediate Breast Reconstruction Safe?

Immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) had comparable safety outcomes to conventional mastectomy alone in breast cancer patients receiving neoadjuvant chemotherapy (NACT), according to a study.

“In this case-control study, no significant difference was noted between the IBR and CM-alone groups in 5-year local recurrence–free, disease-free, and distant metastasis–free survival rates. In addition, there was no significant difference between the groups in 5-year overall survival rates,” the researchers summarized.

The retrospective study analyzed data from the Asan Medical Center in Seoul, Korea, on 1,266 breast cancer patients who underwent NACT before mastectomy with or without breast reconstruction. Propensity score-matching was used to create two cohorts: patients who underwent IBR with NSM/SSM (n=323) versus CM alone (n=323). The primary outcomes were five-year local recurrence-free survival, disease-free survival, distant metastasis-free survival, and overall survival rates.

In propensity score-matched analyses, the median follow-up period (range) was 67 (17-125) months in the IBR group and 68 (17-126) months in the CM alone group. The median age (range) was 42 (23-72) years in the IBR group and 46 (30-75) years in the CM alone group. The IBR and CM groups did not present significant differences in rates of local recurrence (3.7% vs. 3.4%; P=0.83), regional recurrence (7.1% vs. 5.3%; P=0.33), or distant metastasis (17.3% vs. 18.6%; P=0.68). There were also no significant differences between IBR versus CM patients in rates of five-year local recurrence-free survival (95.6% vs. 96.7%; hazard ratio [HR], 1.124; 95% CI, 0.495-2.549; P=0.78), disease-free survival (76.5% vs. 79.9%; HR, 1.089; 95% CI, 0.790-1.500; P=0.60), distant metastasis-free survival (82.5% vs. 82.5%; HR, 0.941; 95% CI, 0.654-1.355; P=0.74), or overall survival (92.0% vs. 89.3%; HR, 0.847; 95% CI, 0.530-1.353; P=0.49)

The study was published in JAMA Surgery.

“The long-term oncologic outcomes of IBR with NSM/SSM for breast cancer in this study appeared to be comparable to those of CM alone after NACT, suggesting the feasibility of IBR with NSM/SSM in the NACT setting,” the researchers wrote in their conclusion.