Comparative Analysis Of Nipple-sparing Mastectomy And Conventional Mastectomy In Young Patients With Breast Cancer

Part 1 Oncological safety of nipple-sparing mastectomy in young patients with breast cancer compared with conventional mastectomyPurpose: This study aimed to find out whether early stage young breast cancer patients who underwent nipple-sparing mastectomy(NSM)are safe in oncology,compare the rates of local recurrence(LR),disease-free survival(DFS)and overall survival(OS)in early stage young breast cancer patients who underwent NSM or conventional mastectomy(CM)and analyze whether there were independent factors affecting the prognosis of young breast cancer patients.Methods: 1.The clinicopathologic data of young breast cancer patients with stage 0 to?B who underwent NSM(163 cases)or CM(194 cases)during January 2007 to June 2016 was collected and retrospectively analyzed.2.Log-rank test was used to analyze the differences between the 5-year LR,DFS and OS rates in the two groups.The clinical TNM stage stratified log-rank test was used to compare the 5-year LR and DFS rates in the two groups.The survival curves were drawn.3.Multivariate analysis was used to analyze whether surgical procedure,age,tumor size,lymph node status,clinical TNM stage,histologic grade,estrogen receptor(ER)status,progesterone receptor(PR)status,human epidermal growth factor receptor-2(HER-2)status were the patients' independent prognostic factors for DFS.Results: 1.All patients were followed up for a period of 4-118 months,with a median follow-up time of 49 months.Patients who underwent CM were more likely to have stage? disease(68.4% vs 58.3%,P=0.015),positive lymph node(45.9% vs 33.1%,P=0.014)and tumor diameter > 2.0cm(67.5% vs 55.2%,P=0.047).2.In the NSM group,LR occurred in 7(4.3%)cases,systemic recurrence in 15(9.2%)cases,and death in 9(5.5%)cases.In the CM group,LR occurred in 6(3.1%)cases,systemic recurrence in 27(13.9%)cases,and death in 15(7.7%)cases.There were no statistical differences between the 5-year LR,DFS and OS rates in the two groups(P>0.05).After adjusting for clinical stage,the 5-year LR and DFS rates between the two groups had no significant differences(P>0.05).3.The analysis of prognostic correlation factors show that clinical TNM stage,lymph node status,ER status,PR status and HER-2 status correlated to DFS(P<0.05).Whether to preserve nipple-areola complex were not the independent prognostic factors for DFS(P>0.05).Conclusion: 1.NSM is safe in oncology for the young breast cancer patients with early stage and nipple-areola complex preserving does not increase the risk of recurrence.2.Lymph node status,clinical TNM stage,ER status,PR status and HER-2 status were the independent prognostic factors for DFS in young patients with breast cancer.Part 2 Complications of nipple-sparing mastectomy in young patients with breast cancer compared with conventional mastectomy and cosmetic outcome of nipple-sparing mastectomyPurpose: This study aimed to compare whether there are differences in the incidence of complications between NSM and CM and analyze the postoperative cosmetic results of the patients who underwent NSM.Methods: 1.The clinicopathologic data of young breast cancer patients with stage 0 to?B who underwent NSM(163 cases)or CM(194 cases)during January 2007 to June 2016 was collected and retrospectively analyzed.All the patients in NSM group underwent breast reconstruction.2.The differences in the incidence of overall complications and various classification complications between the two groups were compared.3.Whether the methods of breast reconstruction,the choice of the donor site for autologous breast reconstruction and the timing of breast reconstruction were the factors that affected the occurrence of complications in the NSM group were analyzed.4.The postoperative cosmetic outcome of the patients who had undergone NSM followed by immediate breast reconstruction was evaluated by patients themselves and a panel comprising three surgeons,and was stratified into 5 grades(excellent,good,acceptable,poor or very poor).Evaluation was based on 4 criteria,including symmetry of size and shape,symmetry of nipple-areolar complex(NAC)and inframammary fold,the visibility of scarring and skin color match.Results: 1.The overall incidence of postoperative complications in the patients who underwent NSM followed by immediate breast reconstruction was higher than that in the CM group,but there were no statistical differences between the two groups(25.8% vs 18.0%,P=0.077).The risk of tissue ischemic necrosis(including NAC,myocutaneous flap and skin necrosis)in the patients of NSM group was significantly higher than that of the CM group(14.4% vs 5.7%,P=0.007).There was no statistically significant difference between the two groups in the incidence of seroma,hematoma and infection(P>0.05).2.The incidence of postoperative complications was significantly higher in the patients with breast reconstruction using implant / expander + implant than the patients using autologous skin flap(40.6% vs 20.1%,P=0.032).The incidence of postoperative complications was significantly higher in the patients with autologous breast reconstruction using abdominal wall as the donor site than the patients using latissimus dorsi(42.9% vs 18.2%,P=0.013).The timing of breast reconstruction was not a factor affecting the postoperative complications in NSM group(P>0.05).3.The overall percentage of patients with ‘excellent' or ‘good' cosmetic outcome in NSM group were 75.2%,‘acceptable' was 18.4% and ‘poor' or ‘very poor' were 6.4%.Conclusion: 1.NSM followed by immediate breast reconstruction did not increase the risk of overall complications in patients,but the incidence of ischemic necrosis after NSM followed by immediate breast reconstruction is significantly higher than that of CM.2.The methods of breast reconstruction and the choice of the donor site for autologous breast reconstruction were the factors that affected the occurrence of complications in the NSM group.3.NSM followed by immediate breast reconstruction could provide patients a superior cosmetic outcome after surgery.