Equivalent survival after nipple-sparing compared to non-nipple-sparing mastectomy: data from California, 1988-2013.
Nipple-sparing mastectomy, which may improve cosmesis, body image, and sexual function in comparison to non-nipple-sparing mastectomy, is increasingly used to treat early-stage breast cancer; however, long-term survival data are lacking. We evaluated survival after nipple-sparing mastectomy versus non-nipple-sparing mastectomy in a population-based cancer registry.



We conducted an observational study using the California Cancer Registry, considering all stage 0-III breast cancers diagnosed in California from 1988 to 2013. We compared breast cancer-specific and overall survival time after nipple-sparing versus non-nipple-sparing mastectomy, using multivariable analysis.



Among 157,592 stage 0-III female breast cancer patients treated with unilateral mastectomy from 1988-2013, 993 (0.6 %) were reported as having nipple-sparing and 156,599 (99.4 %) non-nipple-sparing mastectomies; median follow-up was 7.9 years. The proportion of mastectomies that were nipple-sparing increased over time (1988, 0.2 %; 2013, 5.1 %) and with neighborhood socioeconomic status, and decreased with age and stage. On multivariable analysis, nipple-sparing mastectomy was associated with a lower risk of breast cancer-specific mortality compared to non-nipple-sparing mastectomy [hazard ratio (HR) 0.71, 95 % confidence interval (CI) 0.51-0.98]. However, when restricting to diagnoses 1996 or later and adjusting for a larger set of covariates, risk was attenuated (HR 0.86, 95 % CI 0.52-1.42).



Among California breast cancer patients diagnosed from 1988-2013, nipple-sparing mastectomy was not associated with worse survival than non-nipple-sparing mastectomy. These results may inform the decisions of patients and doctors deliberating between these surgical approaches for breast cancer treatment.
Departments of Medicine, Stanford University School of Medicine, Stanford, CA, USA.|Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Allison W
AW
Kurian
Cancer Prevention Institute of California, Fremont, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA.
Alison J
AJ
Canchola
Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.|Cancer Prevention Institute of California, Fremont, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA.
Scarlett L
SL
Gomez
Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA. tina@cpic.org.|Cancer Prevention Institute of California, Fremont, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA. tina@cpic.org.
Christina A
CA
Clarke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D002140:California / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries; D055815:Young Adult
Breast cancer; Mastectomy; Nipple-sparing; Skin-sparing; Survival
Ann R Coll Surg Engl. 2015 May;97(4):291-7
26263938
Ann Surg Oncol. 2015 Oct;22(10):3324-30
26208581
JAMA. 2010 Sep 1;304(9):967-75
20810374
Am J Surg. 2014 Jul;208(1):93-8
24581994
Breast. 2016 Feb;25:75-81
26612083
Cancer Causes Control. 2001 Oct;12(8):703-11
11562110
Ann Surg Oncol. 2015 Feb;22(2):370-6
25023546
Ann Plast Surg. 2013 Apr;70(4):435-7
23486127
J Clin Oncol. 2009 Sep 1;27(25):4082-8
19636020
N Engl J Med. 2002 Oct 17;347(16):1233-41
12393820
JAMA. 2014 Sep 3;312(9):902-14
25182099
Ann Surg Oncol. 2011 Oct;18(11):3117-22
21847697
Eur J Surg Oncol. 2014 Oct;40(10):1209-15
25186915