Twenty-One Years of Nipple Sparing Surgeries and No Recurrences of Breast Cancer Says a New Georgetown Study

A new study released today suggests that nipple sparing surgery during mastectomy is a safe and effective option for women receiving treatment for breast cancer or for those at high risk who are having surgery to prevent it.

October 27, 2011

Study Suggests NSM is a Safe Alternative to Removing the Nipple after Mastectomy

(Washington, D.C.) – A new study released today suggests that nipple sparing surgery during mastectomy is a safe and effective option for women receiving treatment for breast cancer or for those at high risk who are having surgery to prevent it.

Nipple sparing mastectomy (NSM) involves the removal of the breast tissue while keeping intact the breast skin and nipple areola complex, which includes the nipple and the darker pigmented circle of skin that surrounds it. The breast is usually reconstructed immediately after mastectomy.

A long-standing concern with this type of surgery is that cancer cells might be left under the nipple during surgery, posing a threat of recurrence over time. But clinicians at Georgetown University Hospital examined patient records for all women receiving the surgery between 1989 and 2010 including operations to both treat and prevent breast cancer. "Our findings were very reassuring," said Scott Spear, MD, chairman of the Department of Plastic Surgery at Georgetown. "Of the 162 surgeries performed, we found no cancer recurrences in the nipple and no new cancers in the nipples of those receiving nipple sparing mastectomies. This should be encouraging news to those patients who have had this technique and those who are considering it as a treatment option. We can now provide patients with more information on how successful this procedure can be, and say with increased confidence that the nipple does not need to be removed in every case when a woman has a mastectomy."

The results are published in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons.

Laura Scott, a mother of two children, was 33 in 2010 when she was diagnosed with stage 1 invasive breast cancer. She was a candidate for a lumpectomy but chose a bilateral mastectomy and was eligible for the nipple sparing technique. "I had invasive cancer but it was not located near the nipple. That gave me some hope that NSM would be an option for me so I could be safe, while being as aggressive as possible. This study is incredibly exciting news and it should be encouraging for other women because it's another viable option."

One step credited for why cancers didn't develop later is that surgeons performed biopsies on the tissue that remained under the nipple area after the NSM. If abnormal cells were identified in this tissue, as it was in four cases reviewed, then either the nipple, or the entire nipple areola complex were later removed.

Shawna Willey, MD, chief of breast surgery at GUH and a breast surgeon says the first priority is to always treat or prevent the cancer. "We need to be able to offer women options that they know will successfully treat or prevent their cancer while at the same time, preserve their quality of life whether it be in their appearance or psychologically speaking. Nipple sparing mastectomy goes a long way toward reaching that goal."

"What we've learned from this review is that our established procedures and patient-selection protocol lead to favorable results," confirms Spear. "As more data become available, I think we'll see nipple sparing mastectomy play a larger role, particularly in the prevention setting."

"I was scared to look at myself after my surgery," said Laura Scott. But I was so happy with my end result. If more women knew that yes, it's scary, but you really can look and feel like yourself again, more women would have the nipple sparing procedure."

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