Abstract P4-17-07: Reconstructive Outcomes of Nipple-Sparing Mastectomy: A Five Year Experience

Background: Nipple-sparing mastectomy (NSM) has gained popularity, but remains contoversial as the procedure9s reconstructive outcomes and oncologic safety are still somewhat uncertain. Methods: We retrospectively reviewed the New York University-Langone Medical Center experience with NSM from 2006–2011. Outcomes measured include post-operative complications, breast cancer recurrence, presence of cancer at the nipple-areolar complex, and nipple-areolar complex viability. Results: Our data include patients who underwent NSM from 2006–2011. In total, the records of 235 (145 prophylactic, 90 theraputic) NSM at NYULMC were reviewed. Our reconstructive dta included all forms of reconstruction, including 144 tissue expanders, 74 microvascular free flaps, 16 immediate implants, and 1 combination latissimus dorsi flap with implant. Mean follow-up time was 19 months. No differences existed between the theraputic and prophylactic breast patients. The major complication rate of 4.3% (10/235) included 4 intraoperative hematoma evacuations, 1 flap anastomosis revision, and 3 explanted implants. One patient expired 4 months following surgery secondary to progression of disease. The microvascular free flap loss rate for this group was 0. Minor complications in 6.8% of patients consisted of implant exchange for asymmetry, operative revision of partial flap necrosis, intravenous antibiotics for infection, and 1 non-operative hematoma. In total, 5.9% of nipples were resected due to malignant or premalignant disease. There were 3 positive intraoperative biopsies with 9 additional biopsies positive on final pathology. To date, there have been no recurrences involving the nipple-areolar complex. The viability rate for the remaining nipples was 93.2% with1.7% of nipples undergoing complete necrosis, 3.8% partial necrosis, and 1.3% undergoing epiderolysis. Conclusions: This experience with NSM demonstrates the in a carefully selected cohort, oncologic safety and reconstructive outcome are comparable to the current standard of total mastectomy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-17-07.