A Decade Later: An Updated Systematic Review and Meta-analysis of Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple-Areolar Recurrence Following Nipple-Sparing Mastectomy.

In 30 seconds

This PRISMA-compliant systematic review and meta-analysis updated evidence on oncologic outcomes after nipple-sparing mastectomy (NSM) for breast cancer. It included 60 studies and 7752 NSM patients; 11 studies had comparison groups. In comparative analyses, overall survival showed a pooled risk difference of 2.1% favoring NSM over skin-sparing or modified radical mastectomy (95% CI 0.0-4.3%, p = 0.047), while differences in disease-free survival and local recurrence were not statistically significant. Among patients with 10 years of follow-up, nipple-areolar complex recurrence was 1.1%.

Key findings

• Across 9 comparative studies, the pooled overall-survival risk difference was 2.1% favoring NSM over SSM/MRM (95% CI 0.0-4.3%, p = 0.047).
• The pooled disease-free-survival risk difference was 4.8% favoring NSM, but was nonsignificant (95% CI -0.8 to 10.3%, p = 0.093).
• The pooled local-recurrence risk difference was -0.7% (95% CI -2.1 to 0.8%, p = 0.35), with no significant difference.
• Among patients with 10 years of follow-up (n = 391), nipple-areolar complex recurrence was 1.1% (1.0-1.1%).

Why it matters

Long-term oncologic safety is an important consideration as NSM is increasingly used in breast cancer management. This review brings together survival and recurrence outcomes, including comparisons with other mastectomy approaches, and reports low nipple-areolar recurrence at 10 years. The findings help frame the evidence while distinguishing a significant overall-survival result from nonsignificant differences in disease-free survival and local recurrence.

What to keep in mind

The evidence is based on included studies rather than a single trial; only 11 of the 60 studies had comparison arms. Follow-up varied across groups, and the 10-year outcome estimates were based on 391 patients.