Therapeutic nipple-sparing mastectomy: a scoping review of oncologic safety and predictive factors for in-breast recurrence

Breast cancer is a common disease, with mastectomy remaining necessary in a proportion of patients. Nipple-sparing mastectomy with reconstruction improves cosmesis compared with traditional nipple-sacrificing techniques. However, concerns regarding increased rates of local recurrence in the retained skinfold and nipple-areolar complex exist. The aim of this scoping review is to assess the incidence of in-breast recurrence after therapeutic nipple-sparing mastectomy and analyze predictors of recurrence. A systematic search was conducted using Ovid MEDLINE(R) ALL and Cochrane Library databases, with keywords related to 'nipple-sparing mastectomy' and 'local recurrence'. Studies that reported rates of in-breast recurrence for patients who underwent therapeutic nipple-sparing mastectomy with immediate breast reconstruction were included. 1465 search results were identified, with 17 studies meeting eligibility criteria. The included studies encompassed 7280 patients, with median follow-up time ranging from 28 to 156 months. Nipple-areolar complex, local, regional and locoregional recurrence ranged from 0% to 4.8%, 0% to 10.0%, 0.4% to 3.9% and 1.7% to 24.1%, respectively. A positive linear correlation between recurrence rates and follow-up duration of the included studies was observed. Predictive factors included tumour to nipple distance less than 2 cm, disease stage, molecular subtype and lymphovascular invasion. Nipple-sparing mastectomy is oncologically safe with careful patient selection. Long-term follow-up of patients who undergo nipple-sparing mastectomy may be necessary due to the high rate of late recurrence observed in the included studies.