Both Minimal Access and Conventional Nipple-Sparing Mastectomy Are Safe and Effective for Breast Cancer

 Kim JH, Ryu JR, Bae SJ, et al. Minimal Access vs Conventional Nipple-Sparing Mastectomy. JAMA Surg. 2024.

Cortina CS, Kong AL. Minimally Invasive Nipple-Sparing Mastectomy Can Be Done but Should It? JAMA Surg. 2024.

Minimally invasive nipple-sparing mastectomy (M-NSM) using endoscopic and robotic techniques is increasingly used for surgical management of patients with breast cancer. These procedures are employed for treatment of all stages of breast cancer and for prophylactic mastectomy in patients at high risk for development of breast cancer.

This study examined rates of postoperative complications in 1,583 patients cared for in 21 Korean university hospitals who underwent conventional (C-NSM, mastectomy using a skin incision) or M-NSM; robotic technique was used in 192 patients and endoscopic technique was used in 35 patients.

Outcomes of interest included rates complications occurring within 90 days of the index procedure.

Overall rates of complications at 90 days of follow-up were similar in the two groups (38.7% for C-NSM, 32.1% for M-NSM); necrosis of the nipple-areolar complex (NAC) occurred more often in the C-NSM group. Wound infections and seromas occurred more frequently in the M-NSM group. NAC necrosis was less frequent when axillary incisions and direct-to-implant reconstructive techniques were used.

The authors concluded that C-NSM and M-NSM were both safe and effective approaches.

In the editorial that accompanied the article, Cortina and Kong emphasized the need for additional clinical data that document long-term oncologic outcomes and rates of residual breast tissue following M-NSM.