Abstract:
Background: The vast majority of male breast cancer (MBC) is treated with total mastectomy without reconstruction, while female breast cancer patients are commonly offered less deforming surgical procedures such as partial mastectomy, nipple-sparing mastectomy (NSM) and areolar-sparing mastectomy (ASM). Many men report dissatisfaction with their appearance after total mastectomy due to chest wall concavity and loss of nipple. This underscores the importance of cosmesis-oriented procedures in this population. In this presentation, we will present our series of early stage MBC treated with NSM or ASM, including indications for NSM or ASM, surgical techniques, and clinical and oncologic outcomes. We will review the literature on various surgical operations for MBC, discuss their impact on quality of life, and introduce a modern surgical treatment algorithm for MBC.
Methods: A retrospective review was performed of all MBC patients treated with NSM or ASM during 2015-2021. Patient and tumor characteristics, mastectomy type, surgical margins, complications and recurrences were analyzed.
Results: Four MBC patients, with median age of 58 years (range 47-64), had node-negative invasive cancers ranging from 0.2-2.8 cm in size. Tumor-to-nipple distance ranged from 0.2-1.8 cm on imaging. NSM was performed in two patients; one of the two ASMs was converted from planned NSM due to a positive sub-nipple biopsy. All had negative surgical margins. There were no postoperative complications or recurrences at median follow-up 41 months (range 18-82 months). All verbally reported postoperative cosmetic satisfaction. A new surgical treatment algorithm for MBC was created, incorporating tumor-to-breast ratio, cancer distance to the nipple and results of sub-nipple biopsy into surgical decision making.
Conclusions: Surgical decision making for MBC should be based on similar criteria as for females. Our study established the feasibility of NSM and ASM in MBC with excellent oncologic outcomes and cosmesis. These contemporary surgical techniques should be considered as alternatives to total mastectomy for select MBC patients.
Audience Take Away Notes:
- Understand the oncologic outcomes of less aggressive surgical treatment (ie breast conserving surgery) compared to total mastectomy for MBC
- Understand the impact of total mastectomy with removal of the nipple-areolar complex on quality of life for MBC patients
- Discuss indications for NSM and ASM for select MBC patients
