Nipple areola skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study.
OBJECTIVE
The present study evaluated the oncological safety and technical outcomes following nipple areola skin-sparing mastectomy (NASSM), skin-sparing mastectomy (SSM), and mastectomy.


BACKGROUND
Cosmetic issues associated with breast cancer surgery are important. The original SSM technique included removal of the gland and the nipple areola complex (NAC). However, the risk of tumor involvement of the NAC has been overestimated.


METHODS
This retrospective study included 520 patients who underwent SSM (368 patients) or NASSM (152 patients) with immediate breast reconstruction using a pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and 1990 patients who underwent a mastectomy between July 2001 and December 2006. The indications for NASSM were any stage, any tumor size, and any tumor areola distance. Briefly, the NAC was preserved when the shape, color, and palpation of the nipple were normal.


RESULTS
The median follow-up durations for NASSM and SSM were 60 and 67 months, respectively. Complete nipple areola necrosis developed in 11 (9.6%) NASSM patients. The 5-year disease-free survival rates were 89% and 87.2% for NASSM and SSM, respectively (P = 0.695). The 5-year overall survival rates were similar for NASSM and SSM (97.1% and 95.8%, respectively; P = 0.669). Local failure occurred in 3 (2%) NASSM and 3 (0.8%) SSM patients (P = 0.27). There were 2 (1.3%) nipple areola recurrences in NASSM patients. The LRRs were similar for NASSM and mastectomy patients.


CONCLUSIONS
NASSM with immediate transverse rectus abdominis musculocutaneous reconstruction is a viable surgical treatment in breast cancer patients in any stage. Recurrence and complication rates for NASSM were similar to those for standard surgical breast cancer treatments.
Department of Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Hee Jeong
HJ
Kim
Eun Hwa
EH
Park
Woo Sung
WS
Lim
Jin Young
JY
Seo
Beom Suk
BS
Koh
Taik Jong
TJ
Lee
Jin Sup
JS
Eom
Sung Wook
SW
Lee
Byung Ho
BH
Son
Jong Won
JW
Lee
Sei Hyun
SH
Ahn
D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D009558:Nipples / Q000601:surgery*; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors