Outcomes and Feasibility of Nipple-Sparing Mastectomy for Node-Positive Breast Cancer Patients

Abstract Background While nipple-sparing mastectomy (NSM) is gaining acceptance for risk reduction and for treatment of early stage breast cancer, node-positive disease remains a relative contraindication. Our aim was to evaluate the use and outcomes of NSM in node-positive breast cancer patients. Methods We identified 240 cancers in 226 patients (14 bilateral) scheduled for NSM and operated on between 1/2009-6/2014. We compared outcomes for 58 node-positive versus 182 node-negative patients. Results Intraoperative conversion to skin-sparing mastectomy was similar for node-positive and node-negative patients, 10% and 7%, as was one-year success of NSM, 84% and 90%, respectively. Five-year locoregional disease-free estimates were 82% (95% CI 68-99%) for node-positive and 99% (95% CI 96-100%) for node-negative patients, p=0.004, however there were no nipple-areolar recurrences among node-positive patients. Conclusions With careful consideration of biologic and anatomic risk factors for recurrence, these data suggest NSM is a reasonable option for selected node-positive breast cancer patients.