A recent study on the safety of nipple sparing mastectomy in invasive lobular breast cancer (ILC) has been published in the online version of the Annals of Surgical Oncology.
Titled Oncological Outcomes of Total Skin-Sparing Mastectomy for Invasive Lobular Carcinoma of the Breast: A 20-Year Institutional Experience, the study’s lead author is Dr. Rita Mukhtar, Assistant Professor of Clinical Surgery at the University of California, San Francisco. Dr. Mukhtar is also a member of the Lobular Breast Cancer Alliance’s Scientific Advisory Board.
Dr. Mukhtar commented, “As a breast cancer surgeon, I’m always aware of the risk of positive margins, and especially so in my patients who have ILC. Having data that less extensive removal of skin during mastectomy does not compromise oncologic outcomes is crucial for women to make informed choices about their surgical treatment.”
The following is Dr. Mukhtar’s summary of the study:
Selecting the best surgical procedure for women with lobular breast cancer can be challenging because imaging tests often underestimate tumor size. This means that women with invasive lobular breast cancer (ILC) have high rates of positive margins and repeat operations. They also have high rates of needing mastectomies instead of breast conservation.
Once a woman decides to have a mastectomy, however, there are choices in the type of mastectomy to have (e.g. mastectomy without reconstruction, versus mastectomy with reconstruction but removing the nipple, versus nipple sparing mastectomy). No studies had previously evaluated whether nipple sparing mastectomy is safe in ILC, given the high rates of positive margins and diffuse growth pattern in this tumor type. This study evaluated the rates of positive margins and local recurrences in a group of women with ILC and compared outcomes by type of mastectomy.
We found no difference in outcomes of nipple sparing mastectomy (we call this total skin sparing mastectomy at our institution) compared to other types of mastectomy. This should provide reassurance that women with ILC can safely undergo nipple sparing mastectomy with reconstruction, provided that they are felt to be a good candidate for this procedure by their treating team.