title: Nipple sparing mastectomy: Surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period.
abstract: BACKGROUND
  Nipple sparing mastectomy is deemed surgically and oncologically safe based on a long lasting literature data from reviews of single institution series. This study aims at evaluating surgical and oncological outcomes of NSM on a large multi-institutional scale, by means of the Italian National registry.
  
  
  METHODS
  In July 2011 a panel of Italian specialists agreed upon and designed a National database of NSM. Centers with at least 150 cancers per year and following the National follow-up schedule guidelines could participate inserting any NSM case performed, retrospectively and prospectively from that moment on. In March 2015 analysis of data was accomplished. Dataset for this study consists of cases performed in the period between January 1st 2009 and December 31st 2014.
  
  
  RESULTS
  913 Women were included in the analysis, for a total of 1006 procedures. Prophylactic mastectomies were 124 (12.3%). MRI utilization increased over time. NSM failure rate, with NAC removal for any reason was 11.5%. NAC necrosis rate was 4.8%. Larger skin-flap necrosis rate was 2.3%. Major surgical complications rate was 4.4%. Oncological outcomes were calculated among primitive EBC cases only: locoregional recurrences rate was 2.9%, NAC recurrence 0.7%. Systemic recurrence rate was 1.0%. Five deaths (0.7%) were registered.
  
  
  CONCLUSIONS
  More than 10% of NSM procedures are prophylactic mastectomies. MRI is gaining more importance over time. Surgical and oncological results show that NSM is effective. This National multicentric analysis enables a comparison of results with no geographical differences and a "safe" state of the art of NSM in Italy.
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy. Electronic address: lorenzo.orzalesi@unifi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy. Electronic address: donatocasella@gmail.com.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy. Electronic address: caterinasanti12@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Santi
authors.affiliation: Statistics, Department of Statistics, Informatics and Application "G.Parenti", University of Florence, Viale Morgagni 59, 50134 Florence, Italy. Electronic address: l.cecconi@disia.unifi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cecconi
authors.affiliation: Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, 71013 S.Giovanni Rotondo, Foggia, Italy. Electronic address: romurgo@libero.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Murgo
authors.affiliation: Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, 70123 Bari, Italy. Electronic address: solostefano@alice.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rinaldi
authors.affiliation: Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, 27100 Pavia, Italy. Electronic address: lea.regolo@fsm.it.
authors.forename: Lea
authors.initials: L
authors.lastname: Regolo
authors.affiliation: Breast Unit Surgery, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. Electronic address: claudio.amanti@uniroma1.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Amanti
authors.affiliation: Breast Unit Surgery, Cisanello Hospital, Via Roma 67, 56123 Pisa, Italy. Electronic address: m.roncella@ao-pisa.toscana.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Roncella
authors.affiliation: Breast Unit Surgery, Sant'Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy. Electronic address: magserra@hotmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Serra
authors.affiliation: Breast Unit, Montecchio Maggiore Hospital, Via Ca' Rotte 7, 36075 Montecchio Maggiore, Vicenza, Italy. Electronic address: centro.donna@ulss5.it.
authors.forename: Graziano
authors.initials: G
authors.lastname: Meneghini
authors.affiliation: Breast Unit Surgery, Valdese Hospital, Via Pellico 19, 10125 Turin, Italy. Electronic address: bortolini.m@gmail.com.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bortolini
authors.affiliation: Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy. Electronic address: v.altomare@unicampus.it.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Altomare
authors.affiliation: Breast Unit Surgery, Businco Hospital, Via Jenner 1, 09127 Cagliari, Italy. Electronic address: cabula@tin.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cabula
authors.affiliation: Breast Unit, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy. Electronic address: dr.francescacatalano@virgilio.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Catalano
authors.affiliation: Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy. Electronic address: cirilli.alfredo@libero.it.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cirilli
authors.affiliation: Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, 95126 Catania, Italy. Electronic address: francesco.caruso@ccocatania.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Caruso
authors.affiliation: Breast Unit Surgery, Ramazzini Hospital, Via Molinari 2, 41012 Carpi (Modena), Italy. Electronic address: m.lazzaretti@ausl.mo.it.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Lazzaretti
authors.affiliation: President European Breast Centres Certification, President Senonetwork Italia Onlus, Italy. Electronic address: luigi.cataliotti@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cataliotti
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy. Electronic address: marco.bern@tin.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernini
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009558:Nipples / Q000601:surgery*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Locoregional breast recurrences; National registry; Nipple areola complex necrosis; Nipple areola complex recurrences; Nipple sparing mastectomy