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

Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update on oncologic outcomes following NSM, including overall survival (OS), disease-free survival (DFS), local recurrence (LR), and nipple–areolar complex recurrence (NACR).

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review identified studies reporting oncologic outcomes after NSM. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in the meta-analysis. Studies lacking comparison arms were included in pooled analyses for NSM outcomes using a random-effects model. Weighted averages and 95% confidence intervals (CI) were calculated, and studies were stratified by duration of follow-up.

A total of 60 studies comprising 7752 NSM patients were included: 11 studies had comparison arms; 9 studies reporting OS demonstrated a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM (95% CI 0.0–4.3%, p = 0.047); 7 studies reporting DFS showed a nonsignificant pooled risk difference of 4.8% favoring NSM (95% CI −0.8 to 10.3%, p = 0.093); 11 studies reporting LR demonstrated a nonsignificant pooled risk difference of −0.7% (95% CI −2.1 to 0.8%, p = 0.35). The systematic review included all 60 studies. Weighted average follow-up ranged from 25.6 to 133.4 months across groups. Among patients with 10 years of follow-up (n = 391), OS was 82.0% (80.9–93.2%), DFS 60.7% (58.8–62.7%), LR 15.1% (13.9–16.2%), and NACR 1.1% (1.0–1.1%).

NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM/MRM, with minimal NAC recurrence in appropriately selected patients, supporting its long-term oncologic safety.