The role of radiation therapy after nipple-sparing mastectomy

The aim of this review was to examine the incidence of nipple-areola complex (NAC) involvement, the rates of NAC recurrence, and the data regarding the role of radiation therapy (RT) following nipple-sparing mastectomy (NSM).

A literature review was performed using the PubMed search engine, with articles selected based on standardized criteria. Additional articles included those known to the authors and those obtained by review of references from key studies.

The reported incidence of NAC involvement ranges from 0 to 58 %. The most commonly associated factors with NAC involvement include tumor-to-NAC distance, tumor size, central location of the primary tumor, multicentricity/multifocality, and positive axillary lymph nodes. Following NSM, in the setting of proper patient selection, rates of NAC recurrence are generally low, with the majority of studies reporting rates ranging from 0 to 4 %. There is a paucity of data evaluating the role of RT after NSM and a lack of level I evidence, with the largest series documenting low rates of local recurrence with RT but failing to provide a control arm without radiotherapy.

Optimal preoperative patient selection for NSM and intraoperative assessment of the NAC result in acceptably low rates of NAC involvement/recurrence. NSM alone is not adequate justification for post-mastectomy radiation. NSM should be taken into consideration to inform radiation decision making only when preoperative imaging, clinical features, or pathologic findings suggest higher risk for NAC involvement.