Background:Breast cancer is a complex disease, and local recurrence and cancer-related death is likely multifactorial.Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM). However, oncological safety remains unproven, and the benefits and indications have not been clearly identified
Methods:A Systematic search in the scientific database ( Medline, EMBASE , Google Scholer and Ovid ) from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case–control studies involving women undergoing either NSM were analyzed and included based on the preset inclusion criteria.
Results:The search yielded 1193 articles, of which 55 studies with 9053 patients met our selection criteria. After a mean follow up of 41 months (range, 7.1–78 months), the overall pooled locoregional recurrence rate (LRR) was 3.25%, the overall complication rate was 21.8%(1309 of 6003) , and the overall incidence of nipple necrosis, either partial or total, was 6.6 % (561 of 8438 ). Significant heterogeneity was found among the published studies and patient selection was affected by tumor characteristics.
Conclusion:There is growing evidence that NSM has been marked as oncologically safe in women with small, peripherally located tumors, without multicentricity, or when performed as a prophylactic mastectomy. Hence, NSM has been recommended only if carefully selected for a particular group of patients.