Priya Jadeja1, Richard Ha2, Christine Rohde3, Jeffrey Ascherman3, Robert Grant3, Christine Chin4, Eileen Connolly4, Kevin Kalinsky5, Sheldon Feldman6, Bret Taback7. 1. Department of Breast Surgery, Columbia University Medical Center, New York, NY. 2. Department of Radiology, Columbia University Medical Center, New York, NY. 3. Department of Plastic Surgery, Columbia University Medical Center, New York, NY. 4. Department of Radiation Oncology, Columbia University Medical Center, New York, NY. 5. Department of Hematology/Oncology, Columbia University Medical Center, New York, NY. 6. Montefiore Medical Center, Bronx, NY. 7. Department of Breast Surgery, Columbia University Medical Center, New York, NY. Electronic address: bt2160@cumc.columbia.edu.
Abstract
BACKGROUND: In this study we aimed to review the outcomes of nipple-sparing mastectomy (NSM) in the setting of expanded criteria: previous breast surgery/irradiation, neoadjuvant chemotherapy (NAC), post-NSM irradiation, and to assess conversion to acceptable criteria after NAC. PATIENTS AND METHODS: In this single-institution institutional review board-approved retrospective review, we identified patients who underwent NSM after previous breast intervention or NAC from January 2010 to February 2017. Clinicopathologic features, previous breast surgeries, response rate, complications, and recurrences were recorded. RESULTS: Sixty-three patients underwent 106 NSMs. Among 63 patients, 39 (61.9%) received NAC, 30 (47.6%) previous lumpectomy, 4 (6.3%) with cosmetic implants, 4 (6.3%) with mastopexy, 5 (7.9%) with previous radiation therapy, and 21 (33%) underwent post-NSM radiation therapy. Transient epidermolysis occurred in 24 patients (38.1%), with 16 patients (66.6%) having complete flap recovery and nipple loss in 8 patients (12.6%). All 10 patients with central disease on pre-NAC imaging converted to acceptable criteria, with 9 having successful NSM. At mean 67.2-month follow-up, 56 patients (88.9%) were disease-free, 5 (7.9%) experienced a systemic recurrence, and 2 (3.2%) a local recurrence. CONCLUSION: NSM is oncologically acceptable in this patient cohort. Patients with large central tumors who undergo NAC should be reconsidered after completion of chemotherapy because many might convert to successful nipple-areolar preservation.
BACKGROUND: In this study we aimed to review the outcomes of nipple-sparing mastectomy (NSM) in the setting of expanded criteria: previous breast surgery/irradiation, neoadjuvant chemotherapy (NAC), post-NSM irradiation, and to assess conversion to acceptable criteria after NAC. PATIENTS AND METHODS: In this single-institution institutional review board-approved retrospective review, we identified patients who underwent NSM after previous breast intervention or NAC from January 2010 to February 2017. Clinicopathologic features, previous breast surgeries, response rate, complications, and recurrences were recorded. RESULTS: Sixty-three patients underwent 106 NSMs. Among 63 patients, 39 (61.9%) received NAC, 30 (47.6%) previous lumpectomy, 4 (6.3%) with cosmetic implants, 4 (6.3%) with mastopexy, 5 (7.9%) with previous radiation therapy, and 21 (33%) underwent post-NSM radiation therapy. Transient epidermolysis occurred in 24 patients (38.1%), with 16 patients (66.6%) having complete flap recovery and nipple loss in 8 patients (12.6%). All 10 patients with central disease on pre-NAC imaging converted to acceptable criteria, with 9 having successful NSM. At mean 67.2-month follow-up, 56 patients (88.9%) were disease-free, 5 (7.9%) experienced a systemic recurrence, and 2 (3.2%) a local recurrence. CONCLUSION: NSM is oncologically acceptable in this patient cohort. Patients with large central tumors who undergo NAC should be reconsidered after completion of chemotherapy because many might convert to successful nipple-areolar preservation.
Authors: Carrie K Chu; Matthew J Davis; Amjed Abu-Ghname; Sebastian J Winocour; Albert Losken; Grant W Carlson Journal: Semin Plast Surg Date: 2019-10-17 Impact factor: 2.314
Authors: Tracy-Ann Moo; Carolina Rossi Saccarelli; Elizabeth J Sutton; Varadan Sevilimedu; Kate R Pawloski; Timothy M D'Alfonso; Mary C Hughes; Jill S Gluskin; Almir Bitencourt; Elizabeth A Morris; Audree Tadros; Monica Morrow; Mary L Gemignani; Virgilio Sacchini Journal: Ann Surg Oncol Date: 2021-04-17 Impact factor: 4.339