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. 2016 Nov 29;11(11):CD008932.
doi: 10.1002/14651858.CD008932.pub3.

Nipple- and areola-sparing mastectomy for the treatment of breast cancer

Bruna S Mota  1 , Rachel Riera, Marcos Desidério Ricci, Jessica Barrett, Tiago B de Castria, Álvaro N Atallah, Jose Luiz B Bevilacqua
Affiliations

Nipple- and areola-sparing mastectomy for the treatment of breast cancer

Bruna S Mota et al. Cochrane Database Syst Rev. .

Abstract

Background: The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy.

Objectives: To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women.

Search methods: We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions.

Selection criteria: Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer.

Data collection and analysis: Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria.

Main results: We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical mastectomy (MRM). No participants underwent areola-sparing mastectomy. There was a high risk of confounding for all reported outcomes. For overall survival, the hazard ratio (HR) for NSM compared to SSM was 0.70 (95% CI 0.28 to 1.73; 2 studies; 781 participants) and the HR for NSM compared to MRM was 0.72 (95% CI 0.46 to 1.13; 2 studies, 1202 participants). Local recurrence was evaluated in two studies, the HR for NSM compared to MRM was 0.28 (95% CI 0.12 to 0.68; 2 studies, 1303 participants). The overall risk of complications was different in NSM when compared to other types of mastectomy in general (RR 0.10, 95% CI 0.01 to 0.82, 2 studies, P = 0.03; 1067 participants). With respect to skin necrosis, there was no evidence of a difference with NSM compared to other types of mastectomy, but the confidence interval was wide (RR 4.22, 95% CI 0.59 to 30.03, P = 0.15; 4 studies, 1948 participants). We observed no difference among the three types of mastectomy with respect to the risk of local infection (RR 0.95, 95% CI 0.44 to 2.09, P = 0.91, 2 studies; 496 participants). Meta-analysis was not possible when assessing cosmetic outcomes and quality of life, but in general the NSM studies reported a favourable aesthetic result and a gain in quality of life compared with the other types of mastectomy. The quality of evidence was considered very low for all outcomes due to the high risk of selection bias and wide confidence intervals.

Authors' conclusions: The findings from these observational studies of very low-quality evidence were inconclusive for all outcomes due to the high risk of selection bias.

PubMed Disclaimer

Conflict of interest statement

BS: none known RR: none known MDR: none known TBDC: none known AA: none known JB: none known JLBB: none known

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Overall survival, outcome: 1.1 NSM vs SSM ‐ overall survival.
4
4
Forest plot of comparison: 1 Overall survival, outcome: 1.2 NSM vs MRM ‐ overall survival.
5
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Forest plot of comparison: 2 Local recurrence, outcome: 2.1 NSM vs MRM ‐ local recurrence.
6
6
Forest plot of comparison: 3 Adverse events, outcome: 3.2 Skin necrosis.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008932.pub2

References

References to studies included in this review

Adam 2014 {published data only}
    1. Adam H, Bygdeson M, Boniface J. The oncological safety of nipple‐sparing mastectomy ‐ a Swedish matched cohort study. European Journal of Surgical Oncology 2014;40(10):1209‐15. - PubMed
Boneti 2011 {published data only}
    1. Boneti C, Yuen J, Santiago C, Diaz Z, Robertson Y, Korourian S, et al. Oncologic safety of nipple skin‐sparing or total skin‐sparing mastectomies with immediate reconstruction. Journal of American College of Surgeons 2011;212(4):686‐93. - PubMed
Burdge 2013 {published data only}
    1. Burdge EC, Yuen J, Hardee M, Gadgil PV, Das C, Henry‐Tillman R, et al. Nipple skin‐sparing mastectomy is feasible for advanced disease. Annals of Surgical Oncology 2013;20(10):3294‐302. - PubMed
Gerber 2009 {published data only}
    1. Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple‐areola complex and autologous reconstruction: an extended follow‐up study. Annals of Surgery 2009;249(3):461‐8. - PubMed
Horiguchi 2001 {published data only}
    1. Horiguchi J, Iino JHY, Takei H, Koibuchi Y, Iijima K, Ikeda F, et al. A comparative study of subcutaneous mastectomy with radical mastectomy. Anticancer Research 2001;21(4B):2963‐7. - PubMed
Kim 2010 {published data only}
    1. Kim HJ, Park EH, Lim WS, Seo JY, Koh BS, Lee TJ, et al. Nipple areola skin‐sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study. Annals of Surgery 2010;251(3):493‐8. - PubMed
Oura 1994 {published data only}
    1. Oura S, Sakurai T, Yoshimura G, Tamaki T, Umemura T, Naito Y, et al. Nipple‐preserved mastectomy (Glt + AX) as a standard operation for p‐stage 1, 2 breast cancer. Nihon Geka Gakkai Zasshi 1994;95(12):887‐92. - PubMed
Poruk 2015 {published data only}
    1. Poruk KE, Ying J, Chidester JR, Olson JR, Matsen CB, Neumayer L, et al. Breast cancer recurrence after nipple‐sparing mastectomy: one institution’s experience. American Journal of Surgery 2015;209(1):212‐7. [DOI: ] - PubMed
Sakurai 2013 {published data only}
    1. Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, et al. Long‐term follow‐up of nipple‐sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Medical Oncology 2013;30(1):481. - PubMed
Shi 2012 {published data only}
    1. Shi A, Wu D, Li X, Zhang S, Li S, Xu H, et al. Subcutaneous nipple‐sparing mastectomy and immediate breast reconstruction. Breast Care 2012;7(2):131‐6. - PMC - PubMed
Stanec 2014 {published data only}
    1. Stanec Z, Žic R, Budi S, Stanec S, Milanović R, Vlajčić Z, et al. Skin and nipple‐areola complex sparing mastectomy in breast cancer patients: 15‐year experience. Annals of Plastic Surgery 2014;73(5):485‐91. [DOI: ] - PubMed

References to studies excluded from this review

Algaithy 2012 {published data only}
    1. Algaithy ZK, Petit JY, Lohsiriwat V, Maisonneuve P, Rey PC, Baros N, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis?. European Journal of Surgical Oncology 2012;38(2):125‐9. - PubMed
Alperovich 2014 {published data only}
    1. Alperovich M, Choi M, Frey JD, Lee ZH, Levine JP, Saadeh PB, et al. Nipple‐sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications?. Plastic and Reconstructive Surgery 2014;134(2):202‐6e. - PubMed
Babiera 2010 {published data only}
    1. Babiera G, Simmons R. Nipple‐areolar complex‐sparing mastectomy: feasibility, patient selection, and technique. Annals of Surgical Oncology 2010;17(3):245‐8. - PubMed
Benediktsson 2008 {published data only}
    1. Benediktsson KP, Perbeck L. Survival in breast cancer after nipple‐sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow‐up in 216 patients. European Journal of Surgical Oncology 2008;34(2):143‐8. - PubMed
Caruso 2006 {published data only}
    1. Caruso F, Ferrara M, Castiglione G, Trombetta G, Meo L, Catanuto G, et al. Nipple sparing subcutaneous mastectomy: sixty‐six months follow‐up. European Journal of Surgical Oncology 2006;32(9):937‐40. - PubMed
Chattopadhyay 2014 {published data only}
    1. Chattopadhyay D, Gupta S, Jash PK, Murmu MB, Gupta S. Skin sparing mastectomy with preservation of nipple areola complex and immediate breast reconstruction in patients with breast cancer: a single centre prospective study. Plastic Surgery International 2014;2014:589068. - PMC - PubMed
Crowe 2008 {published data only}
    1. Crowe JP, Patrick RJ, Yetman RJ, Djohan R. Nipple‐sparing mastectomy update: one hundred forty‐nine procedures and clinical outcomes. Archives of Surgery 2008;143(11):1106‐10. - PubMed
de Alcantara Filho 2011 {published data only}
    1. Alcantara Filho P, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS. Nipple‐sparing mastectomy for breast cancer and risk‐reducing surgery: the Memorial Sloan‐Kettering Cancer Center experience. Annals of Surgical Oncology 2011;18(11):3117‐22. - PubMed
Eisenberg 2014 {published data only}
    1. Eisenberg RE, Chan JS, Swistel AJ, Hoda SA. Pathological evaluation of nipple‐sparing mastectomies with emphasis on occult nipple involvement: the Weill‐Cornell experience with 325 cases. Breast Journal 2014;20(1):15‐21. - PubMed
Fortunato 2013 {published data only}
    1. Fortunato L, Loreti A, Andrich R, Costarelli L, Amini M, Farina M, et al. When mastectomy is needed: is the nipple‐sparing procedure a new standard with very few contraindications?. Journal of Surgical Oncology 2013;108(4):207‐12. - PubMed
Garcia‐Etienne 2009 {published data only}
    1. Garcia‐Etienne CA, Cody HS 3rd, Disa JJ, Cordeiro P, Sacchini V. Nipple‐sparing mastectomy: initial experience at the Memorial Sloan‐Kettering Cancer Center and a comprehensive review of literature. Breast Journal 2009;5(4):440‐9. - PubMed
Garwood 2009 {published data only}
    1. Garwood ER, Moore D, Ewing C, Hwang ES, Alvarado M, Foster RD, et al. Total skin‐sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Annals of Surgery 2009;249(1):26‐32. - PubMed
Jensen 2011 {published data only}
    1. Jensen JA, Orringer JS, Giuliano AE. Nipple‐sparing mastectomy in 99 patients with a mean follow‐up of 5 years. Annals of Surgical Oncology 2011;18(6):1665‐70. - PubMed
Leclère 2014 {published data only}
    1. Leclère FM, Panet‐Spallina J, Kolb F, Garbay JR, Mazouni C, Leduey A, et al. Nipple‐sparing mastectomy and immediate reconstruction in ductal carcinoma in situ: a critical assessment with 41 patients. Aesthetic Plastic Surgery 2014;38(2):338‐43. - PubMed
Lohsiriwat 2013 {published data only}
    1. Lohsiriwat V, Rotmensz N, Botteri E, Intra M, Veronesi P, Martella S, et al. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple‐sparing mastectomy?. Annals of Surgical Oncology 2013;20(3):990‐6. - PubMed
Maxwell 2011 {published data only}
    1. Maxwell GP, Storm‐Dickerson T, Whitworth P, Rubano C, Gabriel A. Advances in nipple‐sparing mastectomy: oncological safety and incision selection. Aesthetic Surgery Journal 2011;31(3):310‐9. - PubMed
Missana 2007 {published data only}
    1. Missana MC, Germain MA, Spielman M, Mathieu MC, Rose M, Dunant A, et al. Nipple areola complex conservation in immediate breast reconstruction: prospective study of 66 cases. Journal de Chirurgie 2007;144(6):516‐21. - PubMed
Munhoz 2013 {published data only}
    1. Munhoz AM, Aldrighi CM, Montag E, Arruda EG, Aldrighi JM, Gemperli R, et al. Clinical outcomes following nipple‐areola‐sparing mastectomy with immediate implant‐based breast reconstruction: a 12‐year experience with an analysis of patient and breast‐related factors for complications. Breast Cancer Research and Treatment 2013;140(3):545‐55. - PubMed
Nava 2012 {published data only}
    1. Nava MB, Ottolenghi J, Pennati A, Spano A, Bruno N, Catanuto G, et al. Skin/nipple sparing mastectomies and implant‐based breast reconstruction in patients with large and ptotic breast: oncological and reconstructive results. Breast 2012;21(3):267‐71. - PubMed
Ohno 2013 {published data only}
    1. Ohno Y, Noguchi M, Yokoi‐Noguchi M, Nakano Y, Shimada K, Yamamoto Y, et al. Nipple‐ or skin‐sparing mastectomy and immediate breast reconstruction by the "moving window" operation. Breast Cancer 2013;20(1):54‐61. - PubMed
Paepke 2009 {published data only}
    1. Paepke S, Schmid R, Fleckner S, Paepke D, Niemeyer M, Schmalfeldt B, et al. Subcutaneous mastectomy with conservation of the nipple‐areola skin: broadening the indications. Annals of Surgery 2009;250(2):288‐92. - PubMed
Peled 2014 {published data only}
    1. Peled AW, Foster RD, Ligh C, Esserman LJ, Fowble B, Sbitany H. Impact of total skin‐sparing mastectomy incision type on reconstructive complications following radiation therapy. Plastic and Reconstructive Surgery 2014;134(2):169‐75. - PubMed
Petit 2003 {published data only}
    1. Petit JY, Veronesi U, Orecchia R, Rey P, Didier F, Giraldo A, et al. The nipple‐sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori 2003;89(3):288‐91. - PubMed
Petit 2006 {published data only}
    1. Petit JY, Veronesi U, Orecchia R, Luini A, Rey P, Intra M, et al. Nipple‐sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment. Breast Cancer Research and Treatment 2006;96(1):47‐51. - PubMed
Petit 2009b {published data only}
    1. Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, et al. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European Institute of Oncology of Milan (EIO). Breast Cancer Research and Treatment 2009;117(2):333‐8. - PubMed
Petit 2012 {published data only}
    1. Petit JY, Veronesi U, Orecchia R, Curigliano G, Rey PC, Botteri E, et al. Risk factors associated with recurrence after nipple‐sparing mastectomy for invasive and intraepithelial neoplasia. Annals of Oncology 2012;23(8):2053‐8. - PubMed
Rache Simmons 2004 {published data only}
    1. Simmons RM, Hollenbeck ST, Latrenta GS. Two‐year follow‐up of areola‐sparing mastectomy with immediate reconstruction. American Journal of Surgery 2004;188(4):403‐6. - PubMed
Radovanovic 2010 {published data only}
    1. Radovanovic Z, Radovanovic D, Golubovic A, Ivkovic‐Kapicl T, Bokorov B, Mandic A. Early complications after nipple‐sparing mastectomy and immediate breast reconstruction with silicone prosthesis: results of 214 procedures. Scandinavian Journal of Surgery 2010;99(3):115‐8. - PubMed
Reefy 2010 {published data only}
    1. Reefy S, Patani N, Anderson A, Burgoyne G, Osman H, Mokbel K. Oncological outcome and patient satisfaction with skin‐sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer 2010;29(10):171. - PMC - PubMed
Regolo 2008 {published data only}
    1. Regolo L, Ballardini B, Gallarotti E, Scoccia E, Zanini V. Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast 2008;17(1):8‐11. - PubMed
Rusgby 2010 {published data only}
    1. Rusby JE, Gui G. Nipple‐sparing mastectomy in women with large or ptotic breasts. Journal of Plastic, Reconstructive and Anaesthetic Surgery 2010;63(10):754‐5. - PubMed
Sachinni 2006 {published data only}
    1. Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, et al. Nipple‐sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?. Journal of the American College of Surgeons 2006;203(5):704‐14. - PubMed
Salgarello 2010 {published data only}
    1. Salgarello M, Visconti G, Barone‐Adesi L. Nipple‐sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plastic and Reconstructive Surgery 2010;126(5):1460‐71. - PubMed
Schneider 2012 {published data only}
    1. Schneider LF, Chen CM, Stolier AJ, Shapiro RL, Ahn CY, Allen RJ. Nipple‐sparing mastectomy and immediate free‐flap reconstruction in the large ptotic breast. Annals of Plastic Surgery 2012;69(4):425‐8. - PubMed
Sookhan 2008 {published data only}
    1. Sookhan N, Boughey JC, Walsh MF, Degnim AC. Nipple‐sparing mastectomy ‐ initial experience at a tertiary center. American Journal of Surgery 2008;196(4):575‐7. - PubMed
Spear 2011 {published data only}
    1. Spear SL, Willey SC, Feldman ED, Cocilovo C, Sidawy M, Al‐Attar A, Hannan C, et al. Nipple‐sparing mastectomy for prophylactic and therapeutic indications. Plastic and Reconstructive Surgery 2011;128(5):1005‐14. - PubMed
Stolier 2008 {published data only}
    1. Stolier AJ, Sullivan SK, Dellacroce FJ. Technical considerations in nipple‐sparing mastectomy: 82 consecutive cases without necrosis. Annals of Surgical Oncology 2008;15(5):1341‐7. - PubMed
Tancredi 2013 {published data only}
    1. Harness JK, Vetter TS, Salibian AH. Areola and nipple‐areola‐sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Annals of Surgical Oncology 2011;18(4):917‐22. - PMC - PubMed
    1. Tancredi A, Ciuffreda L, Petito L, Natale F, Murgo R. Nipple‐areola‐complex sparing mastectomy: five years of experience in a single centre. Updates in Surgery 2013;65(4):289‐94. - PubMed
Voltura 2008 {published data only}
    1. Voltura AM, Tsangaris TN, Rosson GD, Jacobs LK, Flores JI, Singh NK, et al. Nipple‐sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria. Annals of Surgical Oncology 2008;15(12):3396‐401. - PubMed
Wagner 2012 {published data only}
    1. Wagner JL, Fearmonti R, Hunt KK, Hwang RF, Meric‐Bernstam F, Kuerer HM, et al. Prospective evaluation of the nipple‐areola complex sparing mastectomy for risk reduction and for early‐stage breast cancer. Annals of Surgical Oncology 2012;19(4):1137‐44. - PMC - PubMed
Wijayanayagam 2008 {published data only}
    1. Wijayanayagam A, Kumar AS, Foster RD, Esserman LJ. Optimizing the total skin‐sparing mastectomy. Archives of Surgery 2008;143(1):38‐45. - PubMed

References to studies awaiting assessment

Additional references

Andersen 1979
    1. Andersen JA, Pallesen RM. Spread to the nipple and areola in carcinoma of the breast. Annals of Surgery 1979;189(3):367‐72. - PMC - PubMed
Banerjee 2008
    1. Banerjee A, Gupta S, Bhattacharya N. Preservation of nipple‐areola complex in breast cancer ‐ a clinicopathological assessment. Journal of Plastic, Reconstructive & Aesthetic Surgery 2008;61(10):1195‐8. - PubMed
Chung 2008
    1. Chung AP, Sacchini V. Nipple‐sparing mastectomy: where are we now?. Surgical Oncology 2008;17:261‐6. - PubMed
Cochrane EPOC Group 2013
    1. Cochrane Effective Practice and Organisation of Care (EPOC) Group. Risk of bias. epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/Suggested%20risk... (accessed 10/10/2013).
de La Cruz 2015
    1. Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM. Overall survival, disease‐free survival, local recurrence, and nipple‐areolar recurrence in the setting of nipple‐sparing mastectomy: a meta‐analysis and systematic review. Annals of Surgical Oncology 2015;22(10):3241–9. [DOI: 10.1245/s10434-015-4739-1] - DOI - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Endara 2013
    1. Endara M, Chen D, Verma K, Nahabedian MY, Spear SL. Breast reconstruction following nipple‐sparing mastectomy: a systematic review of the literature with pooled analysis. Plastic or Reconstructive Surgery 2013;132(5):1043‐54. - PubMed
Ferlay 2012
    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN: Cancer Incidence and Mortality Worldwide: IARC CancerBase. http://globocan.iarc.fr 2012.
Freeman 1962
    1. Freeman BS. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plastic and Reconstructive Surgery and the Transplantation Bulletin 1962;30:676‐82. - PubMed
Gentil 1980
    1. Gentil F, Callia W, Souza e Sá A, Cavalcanti S, Garcia E, Giannotti Filho O, et al. Mammary carcinoma ‐ multidisciplinary treatment with bilateral mastectomy and immediate reconstruction. Journal of Surgical Oncology 1980;14(2):173‐93. - PubMed
Gordis 1996
    1. Gordis L. Epidemiology. Philadelphia: W.B. Saunders, 1996:116‐8.
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. [DOI: ] - PMC - PubMed
Hartmann 2001
    1. Hartmann LC, Sellers TA, Schaid DJ, Frank TS, Soderberg CL, Sitta D. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. Journal of the National Cancer Institute 2001;93:1633‐7. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Josephson 2000
    1. Josephson U, Wickman M, Sandelin K. Initial experiences of women from hereditary breast cancer families after bilateral prophylactic mastectomy: a retrospective study. European Journal of Surgical Oncology 2000;26:351‐6. - PubMed
Lagios 1979
    1. Lagios MD, Gates EA, Westdahl PR, Richards V, Alpert BS. A guide to the frequency of nipple involvement in breast cancer. A study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. American Journal of Surgery 1979;138(1):135‐42. - PubMed
Lakhani 2012
    1. Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Vijver MJ. WHO Classification of Tumours of the Breast. 4th Edition. Vol. 4, IARC Publications, 2012.
Laronga 1999
    1. Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE. The incidence of occult nipple‐areola complex involvement in breast cancer patients receiving a skin‐sparing mastectomy. Annals of Surgical Oncology 1999;6(6):609‐13. - PubMed
Loewen 2008
    1. Loewen MJ, Jennings JA, Sherman SR, Slaikeu J, Ebrom PA, Davis AT, et al. Mammographic distance as a predictor of nipple‐areola complex involvement in breast cancer. American Journal of Surgery 195;3:391‐4. - PubMed
Lostumbo 2010
    1. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database of Systematic Reviews 2010, Issue 11. [DOI: 10.1002/14651858.CD002748.pub3] - DOI - PubMed
Luttges 1987
    1. Luttges J, Kalbfleisch H, Prinz P. Nipple involvement and multicentricity in breast cancer. A study on whole organ sections. Journal of Cancer Research and Clinical Oncology 1987;113(5):481‐7. - PubMed
Menon 1989
    1. Menon RS, Geel AN. Cancer of the breast with nipple involvement. British Journal of Cancer 1989;59(1):81‐4. - PMC - PubMed
Morimoto 1985
    1. Morimoto T, Komaki K, Inui K, Umemoto A, Yamamoto H, Harada K, et al. Involvement of nipple and areola in early breast cancer. Cancer 1985;55(10):2459‐63. - PubMed
Morrow 2002
    1. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. A Cancer Journal for Clinicians 2002;52(5):277‐300. - PubMed
NCI 2013
    1. National Cancer Institute. Fact sheet: cancer staging. www.cancer.gov/cancertopics/factsheet/detection/staging (accessed 4 January 2013).
Norris 2013
    1. Norris SL, Moher D, Reeves BC, Shea B, Loke Y, Garner S, et al. Issues relating to selective reporting when including non‐randomized studies in systematic reviews on the effects of healthcare interventions. Research Synthesis Methods 2013;4(1):36‐47. - PubMed
Parmar 1998
    1. Parmar MKB, Torri V, Stewart L. Extracting summary statistics to perform meta‐analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. - PubMed
Parry 1977
    1. Parry RG, Cochran TC, Jr, Wolfort FG. When is there nipple involvement in carcinoma of the breast?. Plastic and Reconstructive Surgery 1977;59(4):535‐7. - PubMed
Pennisi 1989
    1. Pennisi VR, Capozzi A. Subcutaneous mastectomy data: a final statistical analysis of 1500 patients. Aesthetic Plastic Surgery 1989;13:15‐21. - PubMed
Petit 2009a
    1. Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, et al. Nipple‐sparing mastectomy: risk of nipple‐areolar recurrences in a series of 579 cases. Breast Cancer Research and Treatment 2009;114(1):97‐101. - PubMed
Quinn 1981
    1. Quinn RH, Barlow JF. Involvement of the nipple and areola by carcinoma of the breast. Archives of Surgery 1981;116(9):1139‐40. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. RevMan 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rusby 2008
    1. Rusby JE, Brachtel EF, Othus M, Michaelson JS, Koerner FC, Smith BL. Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy. British Journal of Surgery 2008;95(11):1356‐61. - PubMed
Sacchini 2006
    1. Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, et al. Nipple‐sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?. Journal of the American College of Surgeons 2006;203(5):704‐14. - PubMed
Santini 1989
    1. Santini D, Taffurelli M, Gelli MC, Grassigli A, Giosa F, Marrano D, et al. Neoplastic involvement of nipple‐areolar complex in invasive breast cancer. American Journal of Surgery 1989;158(5):399‐403. - PubMed
Schecter 2006
    1. Schecter AK, Freeman MB, Giri D, Sabo E, Weinzweig J. Applicability of the nipple‐areola complex‐sparing mastectomy: a prediction model using mammography to estimate risk of nipple‐areola complex involvement in breast cancer patients. Annals of Plastic Surgery 2006;56(5):498‐504. - PubMed
Schulz 2010
    1. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Annals of Internal Medicine 2010;152:Epub 24 March. - PubMed
Simmons 2002
    1. Simmons RM, Brennan M, Christos P, King V, Osborne M. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved?. Annals of Surgical Oncology 2002;9(2):165‐8. - PubMed
Singletary 2003
    1. Singletary SE, Robb GL. Oncologic safety of skin‐sparing mastectomy. Annals of Surgical Oncology 2003;10(2):95‐7. - PubMed
Smith 1976
    1. Smith J, Payne WS, Carney JA. Involvement of the nipple and areola in carcinoma of the breast. Surgery, Gynecology and Obstetrics 1976;143(4):546‐8. - PubMed
Verma 1997
    1. Verma GR, Kumar A, Joshi K. Nipple involvement in peripheral breast carcinoma: a prospective study. Indian Journal of Cancer 1997;34(1):1‐5. - PubMed
Veronesi 1990
    1. Veronesi U, Salvadori B, Luini A, Banfi A, Zucali R, Vecchio M, et al. Conservative treatment of early breast cancer. Long‐term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. Annals of Surgery 1990;211(3):250‐9. - PMC - PubMed
Veronesi 2002
    1. Veronesi U, Cascinelli N, Mariani L Greco M, Saccozzi R, Luini A, et al. Twenty‐year follow‐up of a randomized study comparing breast‐conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine 2002;347:1227‐32. - PubMed
Vyas 1998
    1. Vyas JJ, Chinoy RF, Vaidya JS. Prediction of nipple and areola involvement in breast cancer. European Journal of Surgical Oncology 1998;24(1):15‐6. - PubMed
Wetheim 1980
    1. Wertheim U, Ozzello L. Neoplastic involvement of nipple and skin flap in carcinoma of the breast. American Journal of Surgical Pathology 1980;4(6):543‐9. - PubMed

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