ABSTRACT
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-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