The Advantages of Less Invasive Mastectomy Surgery

The Advantages of Less Invasive Mastectomy Surgery
By Roz Plater on May 7, 2019

A less invasive or nipple-sparing mastectomy can be a safer option for more breast cancer patients than previously thought.

That’s according to Mayo Clinic researchers, who presented the findings from their new study last week at the annual meeting of the American Society of Breast Surgeons.

During a webinar, Dr. Judy Boughey, a study co-author and general surgeon at the Mayo Clinic, told journalists that surgeons are performing the procedure successfully on women who wouldn’t have been considered eligible before.

“The initial criteria for suitable patients were based on small breast size, lack of ptosis (drooping), lack of a previous operation, as well as patients with smaller tumors a larger distance away from the nipple,” she said.

“Over recent years we have seen an increase in the indications for [nipple-sparing mastectomies] in our population,” she added. “Patients with more advanced breast cancers and patients with more advanced risk.”

The study by the numbers

The study evaluated the procedure by looking at complication and success rates.

Researchers analyzed the outcomes in 769 women who had the nipple-saving mastectomy procedure between 2009 and 2017.

They found that complications 30 days after surgery declined from 14 percent in 2009 to 6 percent in 2017. This was despite the fact that the procedure was offered to more women, including those whose cancer was locally advanced.

At the one-year mark, reconstruction was considered a success in roughly 97 percent of the cases.

But the study found that recent or current smoking or radiation before surgery significantly increased the rate of surgical complications.

“Today, breast cancer patients who are not offered nipple-sparing procedures should ask their surgeons why,” Dr. Tina Hieken, a study co-author and general surgeon at the Mayo Clinic, said in a news release. “As this study demonstrates, these surgeries are proving safer for a far broader patient base.”

Study analysis

Healthline asked Dr. Deanna J. Attai, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California Los Angeles and a past president of the American Society of Breast Surgeons, to weigh in on what the findings mean when it comes to women with more advanced cancers.

“The number of lymph node–positive women increased from 23 in 2009 to 64 in 2017, so it does appear that women with more advanced stages of cancer are becoming eligible for the procedure,” Attai told Healthline.

She said that goes along with an increased use of neoadjuvant (before surgery) chemotherapy.

“Patients treated with neoadjuvant chemotherapy may have the primary breast tumor as well as axillary nodes ‘downstaged’ by the treatment, allowing for a less traditional surgical approach,” she said.

“Of course, it will be important to have follow-up in these patients on cancer recurrence rates. Right now, they have only assessed 30-day and one-year complications, but not cancer recurrence,” Attai explained.

Should breast cancer patients be asking for the surgery?

“I think women should be aware that this procedure is being performed on a more regular basis, and should inquire if it is right for them,” she said.

“It is important for women to understand that even if all of the skin and the nipple is preserved, there is loss of sensation,” she added. “In addition, there is a small risk of nipple necrosis. And in some cases, cancer is found directly behind or within the nipple, resulting in nipple removal.”

Attai said some patients with large tumors, cancers directly behind or within the nipple, with large breasts, or with a prior history of breast surgery or radiation may not be candidates.

“However as this study notes, eligibility criteria are being expanded with good results,” she added. “Again, long-term results on oncologic safety are needed, especially from this higher-risk patient population.”

Attai said women who are considering the surgery should do their homework.

“The first question a patient should ask is, ‘How many of these procedures do you perform in a year?’” she said.

“It is also reasonable to ask about a surgeon’s complication rates such as nipple necrosis and flap necrosis” she added.

A patient speaks

Elizabeth Sorensen echoes that advice about doing your own research.

The 38-year-old Minnesota woman had a bilateral nipple-sparing mastectomy in January.

“Something I’ve learned on this journey is to be your own health advocate,” she told Healthline.

“If you are facing a mastectomy and your physician hasn’t offered you the option of nipple-sparing mastectomy, you need to raise your voice and ask if you’re a candidate,” she said.

“Research to see who out there is a specialist in this. Find a physician experienced in doing it and look for facilities that have low infection rates. One of the reasons I chose Mayo is because of their low infection rates” she added.

“Going through breast cancer kind of rips you down to your core. I had chemo and had lost all my hair,” Sorensen said. “The fact that I had an option to still keep my nipples and come out of surgery with a chest, definitely put me in a better place.”

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