Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy.
BACKGROUND
Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH).


METHODS
Among 275 NSMs performed from January 2007 to January 2015, 186 cases, with a minimum follow-up of 12 months, were carried out for invasive or intraductal carcinoma. Patients were considered for NSM if there were no clinical and radiological evidence of invasion or close proximity (<1 cm) to the nipple-areola complex (NAC). We compared patients operated with NSM after NCH (Group I N = 51) with those who underwent primary surgery (Group II, N = 135).


RESULTS
At a median follow-up of 35 months, 166/186 patients were alive and disease-free (89.7%). Three local relapses (1.6%) were observed, all in the skin flap outside the NAC in Group I: (6%; p < 0.01). No NAC recurrences have been recorded, in either group. Nipple loss due to full thickness necrosis or resection for insufficient margins was recorded in 31 cases (17%); 12 in Group I (24%) and 19 in Group II (14%) (P = 0.1). This event decreased by half in the second part of the study (21/93 vs 10/93) (P = 0.03).


CONCLUSIONS
NSM after NCH is not associated with a statistically significant difference in terms of post-operative complications, total nipple loss for necrosis or margins, and results improve with experience. The loco-regional relapse rate was higher after NCH, yet it was consistent with traditional mastectomy in the high-risk setting. There is no need to avoid NSM after NCH for locally advanced cancers, if the retro-areolar margins of resection are clear at the time of surgery.
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Stefano
S
Santoro
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Andrea
A
Loreti
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Francesco
F
Cavaliere
Breast Center - Division of Pathology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Leopoldo
L
Costarelli
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Massimo
M
La Pinta
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Elena
E
Manna
Breast Center - Division of Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Maria
M
Mauri
Breast Center - Division of Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Paola
P
Scavina
Breast Center - Division of Radiology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Elena
E
Santini
Breast Center - Division of Radiation Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Ugo
U
De Paula
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
Vito
V
Toto
Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy. Electronic address: lfortunato@hsangiovanni.roma.it.
Lucio
L
Fortunato
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D000075202:Contraindications; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D059351:Organ Sparing Treatments; D012086:Reoperation; D012189:Retrospective Studies
Breast cancer; Mastectomy; Neoadjuvant chemotherapy; Nipple sparing mastectomy