Less-invasive mastectomy safe option for more breast cancer patients

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Even women with locally advanced cancer or at risk of complications could have nipple-sparing surgery.

A less-invasive nipple-sparing mastectomy that leaves the surface of the breast intact has become a safe option for more patients, including those whose breast cancer has spread to nearby lymph nodes or who have risk factors for surgical complications, according to the results of a Mayo Clinic study. The findings were presented at the 2019 American Society of Breast Surgeons Annual Meeting in Dallas.

In a nipple-sparing mastectomy, surgeons remove breast tissue while leaving the skin, nipple and areola intact, and then they immediately perform breast reconstruction.

In their study, researchers evaluated nipple-sparing mastectomy outcomes in 769 women who had the procedure between 2009 and 2017 and found that safety has improved over time. In all, the surgery was performed on 1,301 breasts during the study period.

Complications within 30 days after nipple-sparing surgery declined from 14.8% in 2009 to 6.3% in 2017, even though the procedure was offered to more women, including those whose cancer was locally advanced or women who had surgical complication risk factors such as obesity or prior surgery. At the one-year mark after surgery, reconstruction was considered a success in roughly 97% of cases.

The study found that recent or current smoking or radiation therapy before nipple-sparing surgery significantly increased the rate of surgical complications. In addition, radiation before or after surgery was associated with breast reconstruction failure.

Photo of Tina J. Hieken, M.D.
Tina J. Hieken, M.D.

"Offering enhanced aesthetics as a result of these surgeries to women who have had a devastating diagnosis is extremely rewarding," said senior study author Tina J. Hieken, M.D., a breast surgeon at Mayo Clinic in Rochester, Minnesota. "Today, breast cancer patients who are not offered nipple-sparing procedures should ask their surgeons why. As this study shows, these surgeries are proving safe for a broad patient base."


This article was originally published in Forefront, Mayo Clinic Cancer Center's online magazine, which ceased publication in December 2020.