E. E. Burke1, C. Laronga1, W. Sun1, S. J. Hoover1, N. Khakpour1, J. V. Kiluk1, M. C. Lee1 1Moffitt Cancer Center,Breast Oncology,Tampa, FL, USA
Introduction: Nipple sparing mastectomy has become an option for the treatment and prevention of breast cancer in selected women. Our experience with implant sparing mastectomy suggests that this is a safe and effective option for women with previous retropectoral implant augmentation. We aimed to explore outcomes of patients that underwent concurrent implant and nipple sparing mastectomy (ISNSM) at our institution.
Methods: A retrospective review of patients undergoing ISNSM for either prevention or treatment of breast cancer from 2009 until 2017 was performed at a single institution. Data including patient and tumor characteristics, stage, systemic and radiation therapy use, 90-day complication rates, additional reconstruction, and disease recurrence was collected.
Results: A total of 11 patients were identified after ISNSM; the average BMI was 22.8kg/m2 (range 18.6-30.9). Four (36.4%) had breast cancer in the breast undergoing ISNSM, 3 (27.3%) had a known pre-operative diagnosis of invasive breast cancer or ductal carcinoma in situ (DCIS) in the contralateral breast for which the nipple was excised, and 4 (36.4%) had no disease in either breast. The mean age of the cohort was 48 years, with mean of 52.1 years in those with breast cancer and 41 years in those without breast cancer. Average tumor size was 15mm in breasts treated with ISNSM; all had negative margins of resection, negative analysis of nipple base, and none had disease recurrence after average follow up of 34.9 months (range 0.4-80 months). Final pathological stage was stage 0 for 1 patient, Ia for 3 patients, IIa for 1 patient and IIb for 1 patient. In the 4 disease free patients, 2 were BRCA1+, 1 was BRCA2+, and 1 had a PALB2 mutation. There have been no diagnoses of breast cancer in the 7 patients that pursued implant and nipple sparing mastectomy in breasts without cancer after an average of 33.5 months (range 7-63 months). Ninety-day complication rates in this group were low overall. There was no nipple necrosis, 1 patient developed wound dehiscence with skin flap loss requiring operative intervention, 1 patient required takeback to OR for hematoma and 1 patient had a wound infection requiring antibiotics. Of the 11 patients, 9 (81.8%) have undergone delayed reconstruction requiring only implant exchange. One has not required implant exchange and one has not yet undergone implant exchange. Average time to exchange was 12.5 months (range 3-52 months). None of these patients required delayed flap reconstruction.
Conclusion: ISNSM was effective and well tolerated in this highly selected group of patients with acceptable oncologic outcomes and low complication rates. Patients undergoing this procedure pursued delayed reconstruction and none required flap reconstruction. Further investigation into this option for the treatment and prevention of breast cancer is warranted.