title: Oncologic outcomes and technical considerations of nipple-sparing mastectomies in breast cancer: experience of 425 cases from a single institution.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) is an advantageous treatment option, providing a complete cure and good cosmetic results. We tested whether NSM is a surgically and oncologically safe technique.
  
  
  METHODS
  We evaluated the oncological outcome of 425 breasts in 413 patients who underwent NSM between January 2000 and March 2013. We retrospectively reviewed patient data and analyzed all patient characteristics as potential risk factors of recurrence at the nipple-areola complex (NAC). To confirm the oncological safety of NSM, we compared outcomes of NSM and conventional total mastectomy.
  
  
  RESULTS
  The median follow-up time after surgery was 46.8 months (range 6-158 months). Nipple necrosis was observed in 6 cases (1.4 %). The cumulative local recurrence rate after NSM was 5.8 % (25/425 cases), similar to that of conventional total mastectomy in the same period (5.6 %, 49/878 cases). Furthermore, the cumulative local recurrence rate at the NAC was 2.3 % (10 cases). HER2-enriched tumors and young age (<40 years) were significant risk factors for recurrence at the NAC. In patients with recurrence, the site of recurrence was easily excised, and good cosmetic results were achieved in breast reconstruction cases.
  
  
  CONCLUSIONS
  NSM is safe with a low complication rate. No significant difference was observed in cumulative local recurrence rate, cumulative distant disease recurrence rate, and overall survival between patients who underwent NSM or conventional total mastectomy, confirming that NSM was surgically and oncologically safe.
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan. a2koike@marianna-u.ac.jp.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Shimo
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsugawa
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Tsuchiya
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Yoshie
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Uejima
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kojima
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Shimo
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hayami
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Yabuki
authors.affiliation: Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-Shi, Kanagawa, 216-8511, Japan.|Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sudo
authors.affiliation: Breast and Imaging Center, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Fukuda
authors.affiliation: Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Kanemaki
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Maeda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009558:Nipples; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Local recurrence; NSM; Nipple-sparing mastectomy; Survival; Total mastectomy