ESTRO 2025 - Abstract Book

S596

Clinical - Breast

ESTRO 2025

Conservative mastectomy, including nipple-sparing mastectomy (NSM), is a relatively recent surgical approach for breast cancer, that provides oncological outcomes comparable to non-conservative mastectomies while improving patient satisfaction and psychological well-being. However in cases of histologically positive retroareolar disease, the areola-nipple complex (NAC) is conventionally excised. This study evaluated the feasibility of preserving the NAC in patients with retroareolar disease without compromising oncological outcomes. Material/Methods: A cohort of patients who underwent NSM at our institution between 2016 and 2022, was retrospectively analysed. Retroareolar involvement was confirmed via intraoperative or definitive histological examination. Patients in the NAC preservation group received adjuvant systemic therapy or radiotion therapy, including chest wall irradiation or a localized RT boost to the nipple when indicated. Results: A total of 142 conservative mastectomy were included in the analysis. Among these, 97 (68%) patients underwent NAC excision, while 45 (32%) had NAC preservation. Survival outcomes, including overall survival (OS), disease-free survival (DFS), and distant metastasis-free survival (DMFS), were assessed and compared between the NAC excision and NAC preservation groups. Subgroup analyses were conducted based on disease stage (early-stage n=108; advanced-sta3ge n=34). During an average follow-up of 50 months we registered 8 (5.6%) local recurrence, 5 (5.2%) in NAC excision group and 3 (6.7%) in the NAC preservation. No statistically significant differences in OS, DFS, or DMFS were observed between the two groups, irrespective of disease stage.

Conclusion: These findings suggest that NAC preservation, combined with radiation therapy for patients with retroareolar involvement, may be a feasible alternative to NAC excision, without compromising oncological outcomes. This