2. Introduction
• The nipple areolar complex (NAC) is an important component of the breast, saving (NAC) in
nipple sparing mastectomy procedure lead to better aesthetic, psychological result compared
with other options of treatment, skin sparing mastectomy and simple mastectomy and
improving quality of life.
• The oncologic safety of NSM with immediate breast reconstruction is sufficiently established in
the setting of early-stage peripheral breast cancer based on multiple non randomized studies.
• Tumor to nipple distance (TND) has been evaluated in numerous studies as indication of
NSM.
• However, the cut off distance for considering a patient an appropriate NSM candidate remains
controversial, with different groups recommending a minimum tumour-to nipple distance of
anywhere from 0.5 to 1 cm, to the more conventional 2 cm.
3. • In several published NSM series, patients with a TND<2 cm or<1 cm were
not selected For NSM considering the increased risk of occult nipple
involvement.
• Ponzone et al. suggested that a TND < 5 mm may be appropriate for NSM
eligibility.
• Dent et al. a TND < 1 cm, as measured using preoperative MRI or
sonography, was not associated with an increased risk of NAC
involvement compared with a TND<1 cm after NSM; the authors
concluded that a TND < 1 cm should not be considered a contraindication
to NSM.
4. • Frey et al. found that a TND < 1 cm or< 2 cm trended toward higher rates
of locoregional recurrence.
• The locoregional recurrence rate was 25.0% in patients with a TND < 1 cm
and 2.4% in those with a TND>1 cm after an average follow-up of 48
months, but only four patients with a TND < 1 cm were included in that
analysis.
• In a series of 193 NSMs, Balci et al. reported no significant differences in
the local or nipple recurrence rate between patients with a TND>2 cm and
those with a TND<2 cm after a median follow-up of 62 months (LR 6.7%
vs. 3.7%; nipple recurrence 1.7% vs. 1.5%).
• many surgeons may still hesitate to attempt NSM in patients with a TND <
1 cm , due to possible skipped lesions remaining in the papilla of the
nipple may appear as a subsequent recurrence.
5. • Overall, 1369 patients with primary breast cancer who underwent NSM with immediate reconstruction
from March 2003 to December 2015 were included for analysis.
• at the Asan Medical Centre (Seoul, Korea)
• retrospectively examined using data from a prospectively maintained database
• The primary endpoint of interest was LR as the first event, which was defined as cancer recurrence in the
ipsilateral chest wall, breast skin, or NAC.
• The secondary endpoints were LR-free survival (LRFS) and disease-free survival (DFS) rates.
6. • The indications for NSM were any tumor stage,
tumor
size, or TND.
• TND was calculated as the closest distance between
the tumor and nipple using magnetic resonance
imaging (MRI), ultrasonography, or mammography
performed
for patients before surgery.
• In cases of multifocal or multicentric cancer, the
closest lesion to the nipple was used for calculation
• In all NSM cases, a retroareolar frozen section biopsy
was collected and intraoperatively examined.
• All patients underwent immediate breast
reconstruction via autologous or prosthetic methods
performed by plastic surgeons.
• patients were regularly followed up every 3–6 months
for the first 5 years and annually thereafter.
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12. • A short TND defined by a cut-off value of 1 cm did not compromise the long-term oncologic safety of
NSM.,
• a preoperative TND < 1 cm on imaging should not be contraindicated to NSM as long as there is no
involvement of NAC clinically or on imaging and if retroareolar margins are confirmed to be negative
for tumor cells.
