by Frey, Jordan D.; Salibian, Ara A.;
Karp, Nolan S.; Choi, Mihye
Background: Initially
performed only in prophylactic cases, indications for nipple-sparing mastectomy
have expanded. Trends and surgical outcomes stratified by nipple-sparing
mastectomy indication have not yet been fully examined. Methods: Demographics and
outcomes for all nipple-sparing mastectomies performed from 2006 to 2017 were
compared by mastectomy indication. Results: A total of 1212 nipple-sparing
mastectomies were performed: 496 (40.9 percent) for therapeutic and 716 (59.1
percent) for prophylactic indications. Follow-up time was similar between both
the therapeutic and prophylactic nipple-sparing mastectomy groups (47.35 versus
46.83 months, respectively; p = 0.7942). Therapeutic nipple-sparing
mastectomies experienced significantly greater rates of major (p = 0.0165) and
minor (p = 0.0421) infection, implant loss (p = 0.0098), reconstructive failure
(p = 0.0058), and seroma (p = 0.0043). Rates of major (p = 0.4461) and minor (p
= 0.2673) mastectomy flap necrosis and complete (p = 0.3445) and partial (p =
0.7120) nipple necrosis were equivalent. The overall rate of locoregional
recurrence/occurrence per nipple-sparing mastectomy was 0.9 percent: 2.0
percent in therapeutic nipple-sparing mastectomies and 0.1 percent in
prophylactic nipple-sparing mastectomies (p < 0.0001). Conclusions:
Approximately 40 percent of nipple-sparing mastectomies are currently performed
for therapeutic indications. Therapeutic nipple-sparing mastectomies had higher
rates of infectious complications and reconstructive failure. Rates of
locoregional cancer recurrence/occurrence are low, but occur significantly more
often after therapeutic nipple-sparing mastectomy. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, III.
