Recent trends in nipple sparing mastectomy—a narrative review
Chloe Cheung, Michael Co
Abstract
Background and Objective: Nipple sparing mastectomy (NSM) has become increasingly popular in recent years, both as a treatment for selected cases of breast cancer and for BRCA carriers in prophylactic and therapeutic use. Methods: PubMed, EMBASE, CINAHL and Cochrane were searched for studies on NSM up till June 2020. Key Content and Findings: Different incisions are indicated in different situations and the ultimate decision should be reached after a multi-disciplinary discussion. A common complication of NSM is nipple areolar complex (NAC) necrosis. Therefore, it is imperative for its blood supply to be preserved as much as possible. A deeper understanding of the breast vasculature would also be useful in planning future surgical approach. While NSM offers a superb cosmetic outcome, oncological safety should never be compromised. Short term oncological safety for NSM is evident in recently conducted studies. Three major parameters were evaluated including overall survival, disease-free survival (DFS) and local recurrence rates. In general, NSM is associated with high DFS and low recurrence. As such, carefully selected breast cancer patients and high-risk BRCA patients would benefit from NSM despite occult NAC malignancy being a concern. Conclusions: NSM offers a non-inferior outcome to the conventional mastectomy in selected cases. In the future, randomised controlled trials (RCTs) would be useful in demonstrating the long-term oncologic safety of NSM in breast cancer and BRCA-carrier patients.