Initial Outcomes of a Novel Technique of Nipple Sparing Mastectomy Without Reconstruction
1
Breast Department, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
2
Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(6), 984; https://doi.org/10.3390/cancers17060984
Submission received: 3 February 2025
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Revised: 11 March 2025
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Accepted: 13 March 2025
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Published: 14 March 2025
(This article belongs to the Section Methods and Technologies Development)
Simple Summary
Nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to also conserve their nipple and avoid the transverse scar associated with mastectomy and no reconstruction. This is the first study on the initial oncologic and surgical outcomes of MSM. MSM was oncologically safe with no recurrence after a median follow-up of 41 months. Nipple necrosis was more likely in patients with risk factors including prediabetes and with a greater amount of breast skin for reduction during mastectomy, measured as MRD (mean ring distance) ≥1.5 cm. Excluding the cases with risk factors, nipple necrosis was 9%, which is compatible with the literature. The majority rated the cosmetic outcome as excellent/good. These pilot results will refine the selection criteria of patients for MSM.
Abstract
Introduction: Nipple sparing mastectomy is oncologically safe and has a good cosmetic outcome. However, nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to conserve their nipple areolar complex (NAC) and avoid the transverse scar associated with modified radical mastectomy. This is the first study on the outcomes of MSM. Methods: MSM complications and their risk factors, recurrence rates and cosmetic outcomes were assessed. As MSM is a modification of the round block technique, the mean ring distance (MRD), which is the average of the distance between the inner and outer ring circumferentially, was assessed, too. Results: A total of 28 patients (29 breasts) were analysed. There was no recurrence after a mean/median follow-up of 40.3/41 months (4–80 months). In the initial recruitment of 17 patients (18 breasts), NAC necrosis occurred in eight cases (three complete, five partial). Prediabetes (p = 0.0128) and MRD ≥1.5 cm (p = 0.0440) were statistically significant for NAC necrosis. Of the available data, 11/15 (73.3%) rated the cosmetic outcome as excellent/good, with poorer cosmetic outcome correlated with NAC necrosis (p = 0.006). Avoiding the above risk factors in the next 11 patients, NAC necrosis decreased to 1/11 (9.0%) with mild ischaemia. Cosmetic outcome was rated as excellent/good in 90.9%. Conclusions: MSM is oncologically safe and is best performed in patients with no risk factors for NAC necrosis, including prediabetes and MRD < 1.5 cm. These pilot results will refine the selection criteria of patients for MSM.
