Women with breast cancer who undergo nipple–sparing mastectomy (NSM) have a low rate of the cancer returning within the first five years findings of a single–center study show. The new study, published in the Journal of the American College of Surgeons, found an overall 5.5 percent recurrence rate among 311 operations at a median follow–up of 51 months, with no recurrence involving the retained nipple.

As the Massachusetts General Breast Program team has gained experience over the past decade since the hospital began performing NSM, its patient selection criteria have expanded, principal investigator Barbara L. Smith, MD, PhD, FACS, a surgical oncologist and director of the Breast Program at Massachusetts General Hospital, Boston, said. According to the authors, women with breast cancer are candidates for the NSM procedure unless they have any of the following conditions: clinical or imaging evidence of cancerous involvement of the nipple and areola, which doctors call the nipple–areola complex; locally advanced breast cancer involving the skin; inflammatory breast cancer; or very large or sagging breasts, which would result in an unacceptable location of the nipple.

Dr. Smith credited their success with NSM to advances in breast cancer treatment, her team’s study of breast anatomy, and their surgical techniques. She said her team and most U.S. surgeons thoroughly remove the breast tissue under the “envelope” of breast skin and nipple because they believe that recurrence rates will be lower using this technique. They then remove and test the breast tissue under the nipple. If the biopsy result shows cancer, the surgeon later removes the nipple in an outpatient procedure. Some patients can keep most of the areola, she noted.

In this study, they reviewed medical records of 297 patients whose breast cancer was treated with NSM from June 2007 through December 2012, to analyze rates and patterns of recurrence. Fourteen of these patients had cancer in both breasts and underwent NSM on both sides, for a total of 311 surgical procedures.

More than three–fourths of the women had stage 0 or stage 1 breast cancer, and the remainder had stage 2 or 3 cancer, the investigators reported. They determined that ductal carcinoma in situ, in which cancer cells have not left the milk ducts, was the diagnosis in 23 percent of cases, and the other 77 percent had invasive cancer. Results of the nipple biopsy found cancer in 20 of 311 breasts (6.4 percent), requiring later removal of the nipple or nipple–areola complex.

Because any mastectomy involves cutting nerves in the breast there is a loss of sensation at the nipple. In NSM, a small chance exists that the nipple will wither and the tissue will die, a condition called necrosis. The rate of nipple necrosis in this study was reportedly 1.7 percent.

Patient follow–up rates ranged from four to 101 months after NSM, with most patients having follow–up exams with their oncologists or other physicians for three to five years (56 percent) or longer (21 percent). According to the researchers, the disease–free survival rate – the percentage of patients who were alive and without breast cancer recurrence – was 95.7 percent at three years and 92.3 percent at five years.

Breast cancer recurred in 17 patients at 51 months’ median follow–up. Among these, 10 patients had only local–regional recurrence, meaning the cancer returned in the breast, chest wall, or underarm lymph nodes; two patients had both local–regional and distant recurrence (return of their cancer elsewhere in the body); and seven had distant recurrences alone. The rate of local–regional recurrence that this study reported was 3.7 percent.

No patient had a recurrence involving the nipple–areola complex, the investigators found.