Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis

Radiol Med. 2017 Mar;122(3):171-178. doi: 10.1007/s11547-016-0702-x. Epub 2016 Dec 21.


Objective: To perform a meta-analysis to determine the effect of radiotherapy (RT) on nipple-areolar complex (NAC) and skin flap necrosis, and local recurrence in women who undergo nipple-sparing mastectomy (NSM) and immediate breast reconstruction.

Methods: Medline, PubMed, Cochrane, and Google Scholar databases were searched until October 16, 2015. Randomized-controlled-trials, prospective, retrospective, and cohort studies were included. The primary outcome was the NAC necrosis rate, and the secondary outcomes were the skin flap necrosis and local recurrence rates.

Results: Of 186 studies identified, 2 prospective and 5 retrospective studies including a total of 3692 patients were included in the meta-analysis. Five, 3, and 2 studies reported data of NAC necrosis (3461 breasts), skin flap necrosis (2490 breasts), and local recurrence (988 breasts), respectively. Pooled results showed no difference in the odds of NAC necrosis [odds ratio (OR) = 1.250, 95% confidence interval (CI) 0.481-3.247, P = 0.647], or local recurrence (OR = 0.564, 95% CI 0.056-5.710, P = 0.627) between patients who received and did not receive RT. Patients treated with RT had a higher likelihood of skin flap necrosis (OR = 2.534, 95% CI 1.720-3.735, P < 0.001). Significant heterogeneity, however, was noted in the analysis of NAC and local recurrence.

Conclusions: Because of the limitations of the small number of studies and heterogeneity in the analysis, this study does not allow drawing any definitive conclusions and highlights the need of well-controlled trials to determine the effect of RT in patients undergoing NSM.

Keywords: Breast cancer; Necrosis; Nipple-sparing mastectomy; Nipple–areolar complex; Recurrence.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Mammaplasty
  • Mastectomy / methods*
  • Middle Aged
  • Necrosis / etiology
  • Neoplasm Recurrence, Local*
  • Nipples / pathology*
  • Nipples / radiation effects
  • Odds Ratio
  • Organ Sparing Treatments*
  • Outcome Assessment, Health Care
  • Radiation Injuries / pathology*
  • Radiotherapy / adverse effects
  • Sensitivity and Specificity
  • Surgical Flaps / pathology*