WebMD Medical News
Laura J. Martin, MD
Oct. 27, 2011 -- More women facing mastectomies are opting for surgeries that remove the breast tissue but not the skin, nipple, and areola.
Concerns that a procedure called nipple-sparing mastectomy could raise the risk of a return of cancer have kept the surgery from being widely adopted in the past. That is changing as more surgical centers offer the procedure.
Supporters say that in the right patients nipple-sparing mastectomies can be just as safe and successful as more conventional breast removal.
Now a new study from Georgetown University Medical Center appears to support the claim.
The analysis included data on 101 women who had the surgery at Georgetown University Medical Center between 1989 and 2010 to prevent or treat breast cancer.
Researchers reviewed results for all women receiving the surgery at the center over two decades. They found no evidence of the return of cancer in or near the nipple in close to 50 women with breast cancer over an average of 2 1/2 years of follow-up.
Georgetown chief of plastic surgery Scott L. Spear, MD, who led the research, says other small studies examining nipple-sparing surgery in breast cancer patients have shown the same thing.
But he adds that larger studies with longer follow-up times will be needed.
"I believe this procedure is safe for women with breast cancer and I believe the data will eventually prove that it is safe," he says. "But I would like to see larger, more robust studies."
Spear tells WebMD that he has been performing the surgery for more than a decade, mostly in women at high risk for breast cancer who are having mastectomies to keep from getting cancer.
He says it has only been in the last few years that nipple-sparing surgery has been considered an option for women with breast cancer.
"I spoke last year at a convention to a room with about 400 breast surgeons and I asked how many of them were doing nipple-sparing mastectomies," he says. "Virtually all of them raised their hands. If I had asked the question five years ago, maybe 2% would have been doing them."
Nipple-sparing surgery is considered more challenging than radical mastectomy because the blood supply to the nipple and surrounding skin must be maintained to keep the tissue alive.
Of 162 breasts operated on in the 101 women in the study, 113 of the surgeries were done to prevent breast cancer and 49 were performed as treatment. Three nipples had to be removed later because of tissue death and four others had partial tissue death, requiring additional surgery.
Thirty-nine breast cancer patients in the analysis had biopsies at the time of their surgery. Four (10%) showed evidence of cancer cells in the nipple or surrounding areas, requiring additional surgery to remove the tissue.
The analysis appears in the November issue of Plastic and Reconstructive Surgery.
Cosmetic surgeon Scott Sullivan, MD, FACS, says the now-routine practice of performing biopsies on the nipple during surgery to determine if cancer cells are present had led to the wider acceptance of nipple-sparing mastectomy for the treatment of breast cancer.
Sullivan is co-founder of the Center for Restorative Breast Surgery in New Orleans. "No matter how good your reconstructive results are, if there is a recurrence of cancer the surgery is a failure," he tells WebMD.
The surgery is not appropriate for all breast cancer patients. Women with large tumors or tumors located close to the nipple are not candidates for nipple-sparing mastectomy.
SOURCES:Spear, S.L. Plastic and Reconstructive Surgery, Oct. 27, 2011.Scott L. Spear, MD, chairman, department of plastic surgery, Georgetown University Hospital, Washington D.C.Scott K. Sullivan, MD, FACS, co-founder, Center for Restorative Breast Surgery, New Orleans.News release, Georgetown University Medical Center.
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