By Megan Brooks
NEW YORK (Reuters Health) - 9/5/2019
More women with breast cancer can benefit from less-invasive nipple-sparing mastectomy, according to an analysis of data from the Mayo Clinic presented at the American Society of Breast Surgeons (ASBrS) annual meeting.
The analysis shows that complication and implant failure rates have fallen significantly since nipple-sparing mastectomy was introduced, while the patient population increasingly includes more advanced cancers and women traditionally considered at risk for post-surgery problems.
"Research continues to validate the oncologic safety and enhanced cosmesis of nipple-sparing mastectomies," Dr. Tina Hieken of Mayo Clinic in Rochester, Minnesota, said in statement from the meeting. "Our perception has been that these procedures are increasingly performed on far more complex cases from an oncologic and technical standpoint. However, the results of this study were striking. It not only confirmed this but showed that these surgeries can safely be offered to a far more diverse and challenging group of well-selected patients."
The researchers took a look back at nipple-sparing mastectomies performed on 1,301 breasts in 769 women (mean age, 48) from 2009 to 2017. The one-year reconstruction success rate was 87% in 2009 and rose to 100% in 2017.
The overall 30-day complication rate was 7.5%, with a "dramatic decrease" over time, from 14.8% in 2009 to 6.3% in 2017, despite an increase over the study period in the number of women with obesity, a known risk factor for complications from nipple-sparing surgery, Dr. Judy Boughey of the Mayo Clinic, said during a press briefing on the results.
No patient treated with neoadjuvant chemotherapy had nipple-sparing mastectomy in 2009, while they made up 26% of the population in 2017, suggesting inclusion of higher risk cancer patients in the surgical current pool, the researchers say.
"With the broadening of indications for nipple-sparing mastectomy, we also observed a lower rate of 30-day complications requiring treatment over the time period. These data reflect that the team learning curve for nipple-sparing mastectomy is real and also that the nipple-sparing approach is suitable for appropriately selected higher risk patients both for risk reduction as well as cancer treatment," Dr. Boughey told the briefing.
Prior radiation was significantly associated with complications at 30 days (odds ratio 2.3) and reconstruction failure at one year (OR 4.6). Recent/current smoking (OR 3.3) was associated with 30-day complications.
Commenting on the results in a phone interview with Reuters Health, Dr. Hank Schmidt, breast cancer surgeon at Mount Sinai Health System in New York said, "Nipple-sparing mastectomy has significantly increased in utility over last 10 years and there are a lot of reports to show that it offers comparable oncologic safety when used in cancer patients and is also an important tool for risk reduction for a lot of women."
"This study builds on that previous experience. It's important to recognize that this is a very technically demanding operation, both in the OR and in the entire perioperative setting and if it's done incorrectly, a lot of these patients will suffer the consequences down the road either in terms of recurrence or de novo cancer. So it's important that the surgeon is highly experienced in performing this operation," said Schmidt.
In a conference statement, Dr. Sarah Blair of the University of California San Diego and ASBrS publications committee co-chair said the Mayo Clinic team "clearly demonstrated that careful patient selection and a multi-disciplinary team can improve outcomes over time. This data can educate other surgeons on important factors for patient selection as well as techniques to improve outcomes. We look forward to the long-term oncologic safety data in this higher risk cohort."
American Society of Breast Surgeons Annual Meeting 2019.
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