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Breast

E53: Local Recurrence Among Patients Treated with Nipple Sparing Mastectomy After Neoadjuvant Chemotherapy

Introduction: Rates of nipple sparing mastectomy (NSM) continue to increase and as a result the indications are shifting.  There is limited data regarding the oncologic safety and recurrence rate for patients who undergo NSM after neoadjuvant chemotherapy (NAC).  We evaluated the rate of locoregional recurrence (LRR) for these patients.   

Methods: Patients with breast cancer who had NSM were identified from an institutional prospective database from January 2011 to December 2021.  Patient characteristics, staging, pathology, histology, and LRR were compared between patients who underwent NSM after NAC (NAC group) and those who underwent NSM without NAC (NSM group).

Results: Of the 494 patients who had NSM, there were 79 patients in the NAC group and 415 in the NSM group. Patients were significantly younger in the NAC group (43.5 vs. 49.3, p< 0.0001).  The majority of tumors in both groups were invasive ductal carcinomas, however there were fewer invasive lobular tumors in the NAC group (1.3% vs. 9.2%, p=0.01).  Patients in the NAC group were more likely to have larger tumors (cT2-4: 77.2% vs. 23.6%, p< 0.0001) and more lymph node involvement (cN1-3: 48.1% vs. 7.5%, p< 0.0001) compared to the NSM group.  While the majority of patients in both groups had hormone receptor positive breast cancers (57.0% NAC and 91.1% NSM), the NAC group was more likely to have tumors that were HER2-positive or triple-negative (p< 0.0001).  The rate of complete pathologic response in the NAC group was 44.3% (35/79 patients).  The type of axillary surgery performed was similar between groups. The NAC group was more likely to have adjuvant radiation (53.6% vs. 15.4%, p< 0.0001), but the two groups had similar rates of adjuvant endocrine therapy (53.2% vs. 55.7%, p=0.71). At an overall median follow up time of 58 months, there was no significant difference in the rate of LRR between the groups (2.5% NAC vs. 5.3% NSM, p=0.28).  The 2 LRR in the NAC group were both chest wall recurrences. In the NSM group, 14 were chest wall recurrences, 3 nipple areolar recurrences, and 5 axillary recurrences.  The median time to LRR was similar between the two groups (12.5 months NAC vs. 23.5 months NSM, p=0.26).

Conclusions: Despite presenting with larger tumors and more nodal involvement, LRR for patients who underwent NSM after NAC was similar to those treated without NAC. NSM is an oncologically safe option for patients with breast cancer who undergo NAC. 

Learning Objectives:

  • Upon completion, participant will be able to describe the local recurrence rate for breast cancer patients who undergo nipple sparing mastectomy after neoadjuvant chemotherapy.
  • Upon completion, participant will be able to describe the local recurrence rate is similar for breast cancer patients who undergo nipple sparing mastectomy after neoadjuvant chemotherapy and those without chemotherapy.
  • Upon completion, participant will be able to understand the oncologic safety of nipple sparing mastectomy after neoadjuvant chemotherapy.