More women with breast cancer are likely to benefit from a minimally invasive mastectomy, according to The research was presented on May 2, 2019, at the annual meeting of the American Society of Breast Surgeons (ASBrS) in Dallas. The study showed that the surgical procedure, known as a nipple-sparing mastectomy, is a safe option for a subset of patients.
During nipple-retention surgery, surgeons remove breast tissue while leaving the skin, nipple and areola in place so that they can immediately reconstruct the breast.
The study helps resolve the controversy over whether removing a smaller amount of breast tissue to improve cosmetic outcomes would impair long-term treatment chances or increase rates of surgical complications.
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An increasingly viable option for patients
The study dealt with cases in which breast cancer is limited to the breast. The study authors examined the outcomes of 769 women who underwent nipple-preserving mastectomy between 2009 and 2017. The procedure was performed on 1,301 breasts.
Researchers have found improvements in surgery over time. The complication rate decreased from 14.8 percent in 2009 to 6.3 percent in 2017, despite the fact that the procedure has been offered to more women, including women whose cancer was locally advanced or who had risk factors for surgical complications, such as Obesity or previous surgery.
The study also found that after 2013, obesity was no longer associated with negative outcomes.
Overall, one year after surgery, reconstruction was considered successful in nearly 97 percent of cases, according to the Jodi C Boki, MDis a co-author of the study and a surgeon at the Mayo Clinic in Rochester, Minnesota.
The study showed that some patients are not interested in mastectomy with nipple preservation, including women who are recent smokers or current smokers. In addition, undergoing preoperative radiation increased the rate of complications and failure of breast reconstruction.
“Enlargement of the mastectomy while retaining the nipple can be reasonably considered, and understanding that patient selection is critical,” says Dr. Boki. She adds that it’s important for doctors and patients to discuss the risks and benefits of the procedure.
Overall, however, the study “clearly demonstrated that careful patient selection and a multidisciplinary team can improve outcomes over time,” she says. Sarah Blair, MD, a surgical oncologist at the University of California, San Diego, and co-chair of the ASBRS Publications Committee. Dr. Blair was not involved in the study.
“This data can educate other surgeons about important factors for patient selection as well as techniques for improving outcomes,” says Blair.
Long-term effort pays off
For many years, breast surgeons have tried to avoid mastectomy procedures that remove the entire breast. Some patients undergo a skin-sparing mastectomy, which preserves as much breast skin as possible for reconstruction but includes removal of the nipple and areola, According to BreastCancer.org.
Nipple preservation surgery offers many advantages to patients, including the cosmetic benefits of nipple preservation and less breast tissue removal. This procedure can also be performed at the time of a mastectomy, saving patients from having to return later for reconstructive surgery or procedures to create the nipple.
Mastectomy with nipple-sparing has gained traction in recent years, according to A Review published in July 2016 in the magazine Plastic Surgery Archive. I initially recommend it to patients with small tumors and small breasts, but surgeons have become more comfortable performing the procedure on many types of patients, says Dr. Boki.
“Over recent years, we have seen an increase in indications between patients with more advanced cancer and patients with more risk factors,” Boqi says.
Sparing the nipple does not appear to increase the risk
Other studies also point to the benefits of nipple preservation surgery. Research published in June 2018 in the French magazine Annales de Chirurgie Plastique Esthétique They reviewed 270 articles on nipple-retaining surgery and found that the procedure did not appear to increase the risk of cancer.
Moreover, a A study published in December 2018 in the journal BJS OPEN I searched 690 articles and found similar rates of cancer recurrence with nipple-preserving mastectomy (3.9 percent) compared to skin-conserving mastectomy (3.3 percent), although nipple-preserving mastectomy had a higher complication rate – 22.6 percent, compared to 14 percent.
“Delivering improved aesthetics as a result of these surgeries to women who have had a devastating diagnosis is very rewarding,” he says. Tina Heiken, MDlead author of the new study and a breast surgeon at Mayo Clinic. “Today, breast cancer patients who have not been offered nipple-sparing procedures should ask their surgeon why. As this study shows, these operations have proven safe for a broad base of patients.”
Other news from the annual meeting of the American Society of Breast Surgeons
Patients undergoing breast surgery use fewer opioids than expected
Patients rarely use as many opioid painkillers as their doctors offer after they are discharged from the hospital following breast cancer surgery, according to a study conducted by researchers at the Cleveland Clinic.
The researchers looked at the average number of pills doctors prescribed for 100 patients undergoing either lumpectomy, mastectomy, or mastectomy with reconstructive surgery, and recommended that doctors prescribe 10 pills for lumpectomy patients, 20 for mastectomy patients, and 25 for mastectomy pills. Breast plus- reconstruction patients. However, they found that patients in the three groups used, on average, 1, 3 and 18 pills, respectively. Forty percent of patients did not use any drugs after discharge from the hospital. “These were all significantly lower than described,” says the study author. Stephanie A. Valente, Do, from the Cleveland Clinic in Ohio. “This indicates that a reduction strategy is possible.”
Outpatient mastectomy: It can be done
Two studies confirm that outpatient mastectomy is safe and results in high patient satisfaction. Researchers at Kaiser Permanente looked at 403 outpatient mastectomy procedures and found no difference in emergency department use, readmission to hospital, or outpatient versus inpatient resurgery.
The study is the first large-scale evaluation of surgical recovery at home after mastectomy. According to the study’s lead author Brooke Fong, MDD., of Kaiser Permanente South Sacramento Medical Center in California, as of March 2019, 86 percent of Kaiser mastectomy patients recover at home.
A study from the University of Calgary in Alberta also found no difference in outcomes when patients recovered at home.
