Abstract P5-16-11: Intraoperative central nipple biopsy in subcutaneous mastectomies - A retrospective analysis of 200 patients

Abstract Background: Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant-based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that a general recurrence risk reduction occurs due to elimination of glandular and ductal components within the nipple. In addition, intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. This trial aimed to evaluate complication rates, local recurrence and clean margin resection rates in a head-to-head retrospective manner. Methods: Starting in 2015, intraoperative central nipple biopsy in NSM with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial evaluates global complication rates (necrosis, implant loss, seroma and hematoma), long term local recurrence and clean margin status for cohort 1 (n=100) SSM with nipple biopsy vs. cohort 2 (control, n = 100) without nipple biopsy. In case of an involved central nipple biopsy, the nipple areola complex was removed. This analysis is a single center, multi-surgeon, retrospective, head to head analysis. Median follow-up is three years. All IBR procedures used an epipectoral implant pocket. Results: Global complication rates did not differ significantly between both cohorts. There was no increased rate of implant loss and or revision surgery. Within the medium three-year follow-up there was no case of local recurrence within nipple areola complex for both cohorts. An Involved central nipple biopsy was however found in 2% (n=2 /100) of the performed SSM procedures leading to the immediate removal of the nipple areola complex. Surgical time did not increase with central biopsy. A significantly higher rate of re-surgery due to involved margins was shown in the control cohort. Conclusions: This analysis showed that intraoperative evaluation of the ductal components of the nipple is a safe procedure. At least 2% of the patients showed an immediate advantage of this procedure since clean margins were obtained by removing the nipple areola complex during the same surgery. The medium follow-up showed no significant difference in local recurrence. We therefore strongly, recommend a central nipple biopsy for all NSM procedures. Citation Format: Eichler C, Stephan S, Thangarajah F, Puppe J, Mathias W. Intraoperative central nipple biopsy in subcutaneous mastectomies - A retrospective analysis of 200 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-11.