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Comparative Study
. 2018 Dec 19;3(2):135-145.
doi: 10.1002/bjs5.50119. eCollection 2019 Apr.

Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy

R A Agha  1 , Y Al Omran  2 , G Wellstead  3 , H Sagoo  4 , I Barai  5 , S Rajmohan  5 , M R Borrelli  6 , M Vella-Baldacchino  7 , D P Orgill  8 , J E Rusby  9
Affiliations
Comparative Study

Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy

R A Agha et al. BJS Open. .

Abstract

Background: The use of nipple-sparing mastectomy (NSM) is increasing, despite unproven oncological safety in the therapeutic setting. The aim of this systematic review was to determine the safety and efficacy of NSM compared with skin-sparing mastectomy (SSM).

Methods: A literature search of all original studies including RCTs, cohort studies and case-control studies comparing women undergoing therapeutic NSM or SSM for breast cancer was undertaken. Primary outcomes were oncological outcomes; secondary outcomes were clinical, aesthetic, patient-reported and quality-of-life outcomes. Data analysis was undertaken to explore the relationship between NSM and SSM, and preselected outcomes. Heterogeneity was assessed using the Cochrane tests.

Results: A total of 690 articles were identified, of which 14 were included. There was no statistically significant difference in 5-year disease-free survival and mortality for NSM and SSM groups, where data were available. Local recurrence rates were also similar for NSM and SSM (3·9 versus 3·3 per cent respectively; P = 0·45). NSM had a partial or complete nipple necrosis rate of 15·0 per cent, and a higher complication rate than SSM (22·6 versus 14·0 per cent respectively). The higher overall complication rate was due to the rate of nipple necrosis in the NSM group (15·0 per cent).

Conclusion: In carefully selected cases, NSM is a viable choice for women with breast cancer who need to have a mastectomy. More research is needed to help further refine which surgical approaches to NSM optimize outcomes.

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Figures

Figure 1
Figure 1
PRISMA flow chart showing selection of articles for review. *Two records identified by hand‐searching, 35 from previous systematic reviews and 20 registered trials
Figure 2
Figure 2
Forest plots comparing outcomes for nipple‐sparing versus skin‐sparing mastectomy. a Mortality in the follow‐up interval and b local recurrence outcomes for nipple‐sparing mastectomy (NSM) versus skin‐sparing mastectomy (SSM). Mantel–Haenzsel random‐effects (a) and fixed‐effect (b) models were used. Odds ratios and risk ratios are shown with 95 per cent confidence intervals
See this image and copyright information in PMC

References

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