IMR Press / CEOG / Volume 50 / Issue 5 / DOI: 10.31083/j.ceog5005094
Open Access Original Research
Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques
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1 Breast Unit, Academic Hospital of Udine, 33100 Udine, Italy
2 Ennergi Research, 33050 Lestizza, Italy
3 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
4 Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
5 Institute of Pathologic Anatomy, DAME, Academic Hospital of Udine, 33100 Udine, Italy
6 Clinic of Plastic Surgery, DAME, Academic Hospital of Udine, 33100 Udine, Italy
7 Clinic of Surgery, DAME, University of Udine, 33100 Udine, Italy
*Correspondence: (Serena Bertozzi)
Clin. Exp. Obstet. Gynecol. 2023, 50(5), 94;
Submitted: 28 February 2023 | Revised: 4 April 2023 | Accepted: 10 April 2023 | Published: 6 May 2023
(This article belongs to the Special Issue Breast-Conserving Surgery)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: The introduction of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate reconstruction allowed a noticeable improvement in reconstructive surgery aesthetic results and patients’ psychophysical well-being. In any case, there are still concerns about the long-term oncological safety of these two procedures. This study aims to assess the oncological outcomes of women who underwent SSM and NSM and to compare them with traditional modified total mastectomy (MTM). The secondary outcome was to compare mastectomy with breast-conserving surgery (BCS) outcome. Methods: We performed a retrospective chart review study concerning all patients who had experienced SSM and NSM in our Clinic between January 2004 and July 2013. The main outcomes were overall survival (OS), disease-free survival (DFS), and recurrences cumulative rate. Results: Among this study’s 1836 invasive breast carcinomas, we found NSM (86.7, 95% confidence interval (CI), 76.7–98.0%) to have a significantly shorter 5-year DFS than MTM (90.4%, 95% CI, 87.9–93.0%). Furthermore, low body mass index (odds ratio (OR) 0.733, p = 0.056), basal-like molecular subtype (OR 28.932, p < 0.05), extended intraductal component (OR 11.160, p = 0.107), and lymph node metastasis extracapsular invasion (OR 8.727, p = 0.077) were the most significant predictors of recurrence in women treated with NSM. Furthermore, patients with BCS had significantly longer OS and DFS than those who underwent MTM. Conclusions: Occult nipple neoplastic involvement following negative intraoperative histological examination of subareolar tissue may explain the higher recurrence rate among women undergoing NSM. Patients with one or more risk factors for recurrence after NSM, such as basal-like molecular subtype, extended intraductal component, and extracapsular invasion of lymph node metastasis, should be given special attention.

breast cancer
nipple-sparing mastectomy
skin-sparing mastectomy
disease-free survival
breast-conserving surgery
modified total mastectomy
overall survival
local recurrence
Fig. 1.
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