Evaluating Outcomes For Nipple-Sparing Mastectomy in Patients Over the Age of 60
Nisha Parmeshwar MD*, Laura Barnes MD, Anne Patterson BS, Amanda Miller BS, Scott Hansen MD, Merisa Piper MD
Division of Plastic and Reconstructive Surgery, University of California, San Francisco
Background
•Nipple-sparing mastectomy (NSM) associated with
•Higher patient satisfaction
•Improved body image
•Better psychosocial adjustment
•Acceptable locoregional recurrence rates <5%
•Breast cancer population increasingly > 60 years old
•However, NSM is less frequently offered to elderly
•No published literature regarding outcomes specifically in older patients
ØAIM: Evaluate NSM outcomes in patients over age 60
Methods
•Retrospective review of NSM patients over age 60 from 2004-2022 at UCSF Breast Care Center
•Evaluated demographic, intra-operative, and post-operative variables including skin necrosis and locoregional recurrence
Results
•136 womenà 200 mastectomies
•Mean age 65.2 ± 4.7 years (range 60-86 years)
•Mean BMI 25.0 ± 4.7
Mean follow up 3.4 ± 2.5 years (range <1 year to 14 years
Binary Logistic Regression for any complication, infection, wound breakdown, cancer recurrence [Covariates= Age, BMI, HTN, DM, CAD, HLD, chemotherapy, radiation, invasive disease (IDC, ILC)]
ØPrior radiation increased odds of any complication 2.9x (p=0.009)
ØPrior radiation increased odds of infection 5.7x (p=0.001)
ØDiabetes increased odds of wound breakdown by 9x (p=0.004)
Discussion
•Similar outcomes among older patients over age 60 compared to prior data, institutional and literature
•Locoregional recurrence of 3% in acceptable range
•Diabetes and radiation significantly increased odds of complications (comorbidities may differ in older patients)
•Age alone should not preclude applicable patients from being offered NSM
•Surgery = the single most important factor for Breast Cancer Specific Survival (BCSS) in older patients
•Elderly women should be offered NSM if oncologically safe
Future Directions
ØIncreased sample size of NSM > 60 years
ØPropensity-matched cancer control comparison to younger patients
