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The following is a summary of “Initial oncological outcomes of nipple- and areola-sparing mastectomy in patients with breast cancer with nipple discharge,” published in the April 2025 issue of World Journal of Surgical Oncology by Hou et al. 

This study evaluated the oncological safety of nipple- and areola-sparing mastectomy (NSM) compared to traditional mastectomy without preservation of the nipple-areola complex (NAC) in patients with breast cancer presenting with nipple discharge. Given concerns about potential tumor involvement of the NAC in such cases, the investigation aimed to determine whether NSM compromises oncological outcomes in this specific clinical context.

A retrospective analysis was conducted on 226 patients diagnosed with non-metastatic breast cancer who underwent surgical treatment between March 2015 and August 2023 at two institutions. Of these, 93 patients received NSM, while 133 underwent conventional mastectomy without NAC preservation. All patients presented preoperatively with bloody or serous nipple discharge. Clinical and pathological data were reviewed to compare local recurrence rates, DFS, and OS between the two groups. Additionally, prognostic factors influencing outcomes were identified through univariate and multivariate statistical analyses.

There were no statistically significant differences in local recurrence rates or DFS between the NSM and non-NSM groups at both 3-year and 5-year follow-up intervals (p > 0.05), suggesting that preservation of the NAC does not compromise oncological safety in this subset of patients with breast cancer. Univariate analysis revealed that tumor T stage, lymph node metastasis count, and histological grade were significantly associated with both DFS and OS (p < 0.05). Specifically, tumors exceeding 2 cm in size, positive nodal status, and grade III histology were linked to an increased risk of recurrence and mortality. Multivariate analysis further confirmed that higher T stage and greater lymph node involvement were independent predictors of poorer DFS and OS outcomes.

The findings support the oncological safety of NSM in patients with breast cancer presenting with nipple discharge, provided appropriate patient selection and careful surgical planning. Tumor burden, as indicated by size and nodal involvement, along with histological grade, was a significant prognostic indicator of recurrence and survival. These results suggest that NSM can be safely considered in selected patients, even when nipple discharge is present, without compromising long-term outcomes.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-025-03792-4