I don’t know if breast cancer rates are continuing to rise or if all my friends are just old enough where breast cancer seems to be everywhere. So many of us have had the scare of a possible cancer or have actually had breast cancer and had to think.
What would we do if we got breast cancer?
Would we do a lumpectomy? Mastectomy (remove the whole breast)? Would we need chemo? Radiation? And if we did a mastectomy could we save the nipple?
April 2015 issue of Plastic and Reconstructive Surgery Journal had a study out of Mass General. Is it okay to do a nipple sparing mastectomy if you know you are getting radiation? (Or as they say, “Breast Reconstruction Outcomes after Nipple Sparing Mastectomy and Radiation Therapy.”) Many times women choose to do a total mastectomy to try to avoid radiation. But if your cancer is close to the margin, you have positive lymph nodes, or other reasons, you may need radiation even when you did a total mastectomy.
This was a retrospective analysis of 605 reconstructions at a single institution from 2007-2012. Of these, 88 patients had radiation therapy after surgery. What did they find?
- There are more complications in patients with radiation (19% vs 12%)
- secondary procedures for capsular contracture
- fat grafting
- There is more implant loss (6% vs 1%)
- Preop raditation gave higher risk of total complications
- Post op radiation gave higher risk of explant (implant needs to be removed)
- There were NO significant differences in nipple removal from malposition or positive oncologic margins
Nipple retention rate was 90%.
So can you save the nipple when doing a mastectomy when you know you will get radiated? They concluded yes. Though at higher risk for complications, most patients have successful breast reconstructions with viable nipples and no recurrences.