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Nipple-Sparing Mastectomy as Good as Full Breast Removal: Study

Women with early stage breast cancer who chose to preserve the nipple during a mastectomy had similar survival or recurrence rates to women who underwent full breast removal, a new study found.

“Nipple-sparing surgery is oncologically safe in carefully selected women with early stage breast cancer,” said Dr. Lucy De La Cruz, a researcher at the University of Miami. She was scheduled to present her findings Thursday at the American Society of Breast Surgeons annual meeting, in Orlando, Fla.

Studies presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

In nipple-sparing surgery, the nipple and the darkened area around the nipple—the areola—are left in place. The breast tissue is taken from underneath the nipple area, according to the American Cancer Society (ACS). Although the nipple area is preserved, blood flow and nerves are affected. That means the nipple usually has little to no feeling, and it’s possible the appearance of the nipple may be affected, the ACS noted.

For the new study, De La Cruz pooled the findings of 19 previously published studies, an approach known as a meta-analysis. The studies included more than 5,000 patients.

De La Cruz compared outcomes in women who had nipple-sparing surgery to those who had full breast removal. De La Cruz looked at the two approaches in terms of how often the cancer came back, including how often it recurred at the nipple area, and survival. The nipple-sparing procedure was as safe as a standard full breast removal for all of these measures, the review found.

Six of the studies that compared overall survival between nipple-sparing and non-nipple-sparing surgery even found a 2.5 percent increased chance of survival in women who had the nipple-sparing procedure.

Dr. Irene Wapnir, chief of breast surgery and professor of surgery at Stanford University School of Medicine, said, “This review of the published literature is certainly reassuring about the safety of nipple-sparing mastectomy in patients who are appropriately selected.”

But not all women are candidates for the nipple-sparing surgery, which has been performed in the United States for about 15 years, according to Wapnir. For instance, if the breast cancer is too close to the nipple area, the nipple-sparing surgery may not be possible.

Use of the procedure has increased markedly in the past 10 years, Wapnir said.

However, it’s still not a common procedure, with less than 5 percent of U.S. doctors offering the procedure, said Dr. Julie Margenthaler, a surgeon at the Siteman Cancer Center at Washington University in St. Louis.

The nipple-sparing operation is more challenging than a full mastectomy, Margenthaler said. Costs are similar, however, as is insurance reimbursement, she said.

Women need to be warned that nipple sensation will likely be dramatically altered, Wapnir said, especially in response to sexual arousal.

However, the nipple-sparing surgery does give a more natural look after reconstruction than other techniques, she said.

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SOURCES: Lucy De La Cruz, M.D., researcher, University of Miami, Miami, Fla.; Irene Wapnir, M.D., chief of breast surgery and professor of surgery, Stanford University School of Medicine, Stanford, Calif.; Julie Margenthaler, M.D., surgeon, Siteman Cancer Center, Washington University, St. Louis, Mo.; April 30, 2015, news conference and presentation, American Society of Breast Surgeons annual meeting, Orlando, Fla. 



 

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