A. J. Bartholomew1, K. F. Griffith1, G. M. Lassiter1, S. Mehra1, M. Sosin2, D. L. Caragacianu1, S. C. Willey1, E. A. Tousimis1 2NYU Langone Health,Hansjörg Wyss Department Of Plastic Surgery,New York, NY, USA 1MedStar Georgetown University Hospital,Breast/Surgery,Washington, DC, USA
Introduction: Rates of nipple-sparing mastectomy (NSM) continue to increase due to improved cosmesis and demonstrated oncologic safety. Successful outcomes have led to expanded patient selection in those who were traditionally considered to be non-ideal candidates. This study aims to characterize changes in patient selection for NSM over one decade at a single institution.
Methods: A single-institution, retrospective chart review identified all NSMs occurring from Jan 2008 through Dec 2017. Patient demographics traditionally included for patient selection criteria were collected including age, BMI, smoking history, breast size, ptosis, and history of radiation. Macromastia was defined as breast size larger than a C cup, obesity was defined as BMI > 30, smoking status was defined at the time of diagnosis, and ptosis was recorded as clinically significant if grade two or higher. Primary outcomes were differences in patient demographics evaluated by chi-squared and Student’s t-test across the decade in two bins (2008-2012 vs. 2013-2017). History of radiation was evaluated by breast, while all other variables were evaluated at the patient level.
Results: A total of 492 patients and 847 breasts were included in the final cohort spanning ten years. From 2008 to 2012, 157 (31.9%) patients underwent NSM, while 335 (68.1%) NSMs occurred from 2013 to 2017. The mean age of the cohort was 46.1 years (SD = 10.2), BMI was 23.6 kg/m2 (SC = 4.0), obesity was present in 39 (7.9%) of patients, 20 (4.1%) were current smokers, 92 (20.9%) had macromastia, and 51 (6.2%) breasts had a history of prior radiation. In the second half of the decade, patients were older (46.8 vs 44.7 years, p = 0.033), had larger BMIs (24.0 vs 22.8 kg/m2, p = 0.027), and a greater proportion had obesity (10.2% vs 3.2%, p = 0.004) and macromastia (23.8% vs 14.9%, p = 0.029; Table 1). There was no significant difference between the first and second halves of the decade in the proportion of active smokers (4.5% vs 3.9%, p = 0.758, respectively), patients with clinically-significant ptosis (33.3% vs 38.3%, p = 0.462), or breasts with a history of prior radiation (7.4% vs 5.7%, p = 0.389).
Conclusion: Over the last decade, indications for NSM have continued to expand to non-ideal patients. Our institution performed NSMs on a significantly increased proportion of women with larger breasts, higher BMIs, and older age throughout the last decade.
