Is Minimal Access Nipple-Sparing Mastectomy a Safer Option?

TOPLINE:

In patients with early breast cancer, the overall complication rates were similar among those who underwent minimal access nipple-sparing mastectomies and those who underwent conventional nipple-sparing mastectomy, but the rates of specific complications varied. Given that both procedures appear safe overall, the choice may be guided by patients’ preference.

METHODOLOGY:

• Compared with a conventional mastectomy, a nipple-sparing mastectomy offers superior esthetic outcomes in patients with breast cancer. However, even the typical nipple-sparing approach often results in visible scarring and a high risk for nipple or areola necrosis. A minimal access approach, using endoscopic or robotic techniques, offers the potential to minimize scarring and better outcomes, but the complication risks are not well understood.
• Researchers performed a retrospective study that included 1583 patients with breast cancer who underwent conventional nipple-sparing mastectomy (n = 1356) or minimal access nipple-sparing mastectomy (n = 227) between 2018 and 2020 across 21 institutions in the Republic of Korea.
• Postoperative complications, categorized as short term (< 30 days) and long term (< 90 days), were compared between the two groups.
• The minimal access group had a higher percentage of premenopausal patients (73.57% vs 66.67%) and women with firm breasts (66.08% vs 31.27%).

TAKEAWAY:

• In total, 72 individuals (5.31%) in the conventional nipple-sparing mastectomy group and seven (3.08%) in the minimal access nipple-sparing mastectomy group developed postoperative complications of grade IIIb or higher.
• The rate of complications between the conventional and minimal access nipple-sparing mastectomy groups in the short term (34.29% for conventional vs 32.16% for minimal access; P = .53) and long term (38.72% vs 32.16%, respectively; P = .06) was not significantly different.
• The conventional group experienced significantly fewer wound infections — both in the short term (1.62% vs 7.49%) and long term (4.28% vs 7.93%) — but a significantly higher rate of seroma (14.23% vs 9.25%), likely due to the variations in surgical instruments used during the procedures.
• Necrosis of the nipple or areola occurred more often in the minimal access group in the short term (8.81% vs 3.91%) but occurred more frequently in the conventional group in the long term (6.71% vs 2.20%).

IN PRACTICE:

“The similar complication rates suggest that both conventional nipple-sparing mastectomy and minimal access nipple-sparing mastectomy may be equally safe options,” the authors wrote. “Therefore, the choice of surgical approach should be tailored to patient preferences and individual needs.”

SOURCE:

The study, led by Joo Heung Kim, MD, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea, was published online on August 14, 2024, in JAMA Surgery.

LIMITATIONS:

The retrospective design comes with inherent biases. The nonrandom assignment of the participants to the two groups and the relatively small number of cases of minimal access nipple-sparing mastectomy may have affected the findings. The involvement of different surgeons and use of early robotic surgery techniques may have introduced bias as well.

DISCLOSURES:

This study was supported by Yonsei University College of Medicine and the National Research Foundation of Korea. Two authors reported receiving grants and consulting fees outside of this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.