To investigate the safety and postoperative cosmetic effect of nipple-areola complex sparing mastectomy (NSM) combined with immediate breast reconstruction using implant.

We retrospectively analyzed the clinical data of 81 patients with breast cancer who underwent NSM or mastectomy combined with immediate breast reconstruction using implant from March 2011 to December 2018 in the Women and Children’s Hospital of Guangdong Province, including 45 patients with NSM plus implant breast reconstruction and 36 patients with mastectomy plus implant breast reconstruction. All patients were followed up for 4 to 97 months, median 36 months. The Harris standard was used to evaluate postoperative cosmetic effect, and the functional assessment of cancer therapy-breast (FACT-B) was used to evaluate postoperative quality of life of the patients. The χ² test was used to compare clinicopathological characteristics, rate of excellent and good cosmetic effect and incidence of postoperative complications between two groups; the nonparametric test of two independent samples (Mann-Whitney U test) were used to compare the postoperative cosmetic effects between two groups; the t test was used to compare the quality of life scores between two groups. The Kaplan-Meier method and log-rank test was used for survival analysis.

There was no significant difference in the incidences of postoperative short-term and long-term complications between the NSM plus implant breast reconstruction group and the mastectomy plus implant breast reconstruction group [24.4%(11/45) vs 22.2%(8/36), χ²=0.055, P=0.815; 2.2%(1/45) vs 2.8%(1/36), P=1.000]. As for postoperative appearance, the number of patients with excellent, good, moderate and poor cosmetic effect was 14, 7, 9 and 6 in the mastectomy plus implant breast reconstruction group, 20, 18, 5 and 2 in the NSM plus implant breast reconstruction group, indicating no significant difference(Z=-1.626, P=0.104). The patients with excellent and good cosmetic effect accounted for 84.4% (38/45) in the NSM plus implant breast reconstruction group, 58.3% (21/36) in the mastectomy plus implant breast reconstruction group, indicating a significant difference (χ²=6.892, P=0.009). As for quality of life, the NSM plus implant breast reconstruction group presented significantly higher scores in three sections including physical well-being, social/family status, and additional condition, compared with the mastectomy plus implant breast reconstruction group (t=2.720, 2.585, 3.160, P=0.009, 0.013, 0.004), while the scores of emotional status and functional status showed no significant difference(t=0.396, 1.258, P=0.694, 0.212). Three cases had recurrence and metastasis, including 2 cases in the NSM plus implant breast reconstruction group (one case of recurrence in nipple-areola complex, one in axillary lymph node), and one case of local recurrence and mediastinal lymph node metastasis in the mastectomy plus implant breast reconstruction group. The DFS showed no significant difference between two groups (χ²=0.398, P=0.528). The 5-year OS in both groups was 100%.

Compared with mastectomy plus implant breast reconstruction, NSM plus implant breast reconstruction increases little risk of postoperative complications, and shows a higher rate of excellent and good cosmetic effect and higher scores in quality of life. It is a surgical option in clinic under the premise of carefully restricting its indications.