E77: Nipple Preserving Surgical Candidates in Male Breast Cancer Patients

Men with breast cancer are more likely than women to be treated with mastectomy rather than a nipple preserving surgery such as breast conservative therapy or nipple sparing mastectomy even though data has shown similar survival rates and improved quality of life.  Our aim is to characterize the surgical management of a contemporary cohort of male breast cancer patients in our hospital system and identify trends associated with type of surgery and operative and pathological outcomes. We hypothesized that men continue to receive more extensive surgical treatment for breast cancer regardless of nipple areolar involvement without long term benefit.

Methods: Retrospective review of all male breast cancer patients that underwent definitive surgical treatment in a single hospital system between January 2013 and August 2023.

Results: A total of 56 men were identified with breast cancer. Forty-four (78.6%) of them underwent mastectomy, six (10.7%) of them had nipple preserving surgery, and six (10.7%) patients were excluded due grossly metastatic disease and did not undergo surgical intervention. Of the patients that underwent mastectomy, 41.9% showed nipple areolar involvement of the tumor on final pathology, 33.3% of them being stage IIA or higher. Forty-five of the 50 male breast cancer patients (90%) had preoperative ultrasound or mammogram, and 10 (22%) patients had an additional preoperative MRI. Of the patients that had an MRI, 5 (50%) of them were able to identify a surgical plane between tumor and the nipple areolar complex, all of which were also negative on pathology. Of the 27 (55.1%) male breast cancer patients that showed possible nipple areolar involvement of the dermis on imaging, 18 (66.7%) were actually involved on pathology. Eight (16%) of the male breast cancer patients developed breast cancer recurrence, all of which were mastectomy patients.  Breast cancer recurrence occurred approximately 41 months after treatment, and six (12.2%) patients passed away during January 2013- August 2023.

Conclusions: Six of 50 males with diagnosed breast cancer underwent a nipple preserving surgery although a majority did not show nipple areolar involvement on final pathology. Nipple sparing procedures such as breast conversative therapy and nipple sparing mastectomies should be considered for appropriate male breast cancer patients. Involvement seen on radiographic images are not a good predictor of tumor involvement of the nipple areolar complex seen on final pathology results. MRI may be helpful to determine nipple sparing surgery candidacy for male breast cancer patients.