Nipple-sparing mastectomy (NSM) in the setting of breast cancer preserves the nipple-areola complex (NAC) and breast skin envelope. While previous studies have shown that NSM is an acceptable surgical option in select patients with breast cancer, there is limited long-term outcomes data for this approach. In this retrospective cohort study, outcomes for 962 breasts from 944 patients that underwent NSM at a single institution were followed up (median follow-up time 85 months) to assess the incidence, risk factors and long-term outcomes associated with cancer recurrence at the NAC. Researchers found that 4.1% of patients experienced disease recurrence at the NAC as the first event after NSM. The 5-year cumulative incidence of cancer recurrence at the NAC was 3.5%. Based on multivariate analyses, a number of risk factors were identified as independent risk factors for cancer recurrence at the NAC following NSM, including mutlifocality or multicentricity (HR 3.309, 95% CI 1.501 to 7.294, p=0.003), negative hormone receptor or ERBB2 subtype (HR 3.051, 95% CI 1.194 to 7.796, p=0.02), high histologic grade (HR 2.641, 95% CI 1.132 to 6.160, p=0.03) and extensive intraductal component (HR 3.338, 95% CI 1.262 to 8.824, p=0.02). Metastasis-free survival and overall survival did not significantly differ between patients that did and did not develop cancer recurrence. This study therefore shows that the incidence of cancer recurrence at the NAC after NSM and immediate breast reconstruction is low. Risk factors for recurrence at the NAC following NSM, however, should be taken into consideration in providing individualized cancer care.
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