Variation in adoption of skin and nipple sparing mastectomy: An opportunity to enhance patient outcomes


      • Nipple-sparing mastectomies are cosmetically preferable and oncologically safe.
      • Patients have reports improved psychosocial well-being with NSM.
      • Surgeon volume and neoadjuvant therapy were associated with increased odds of NSM.
      • Opportunities for low-volume surgeons to enhance patient outcomes.



      Nipple-sparing mastectomies (NSM) for breast cancer are under-utilized. We sought to investigate NSM utilization.


      Females with nonmetastatic breast cancer undergoing mastectomy in the Legacy Health System from 2007 to 2020 were identified. Multivariable logistic regression was utilized to evaluate odds of receiving NSM.


      Three-thousand-four-hundred-seventeen mastectomies were performed with 772 undergoing NSM. On multivariable analysis, later year (OR 1.22/year, P < 0.001), neoadjuvant chemotherapy (OR 1.33, P = 0.04), HR+ (OR 1.61, P = 0.001) and surgeon volume (OR 1.16/10 yearly mastectomies, P < 0.001) were independently associated with increased odds of receiving a NSM while age (OR 0.94/year, P < 0.001), IDC (OR 0.58, P = 0.01), T3/T4 stage (OR 0.36, P = 0.009), and clinical node positivity (OR 0.63, P = 0.003) were independently associated with decreased odds. Surgeon volume was not associated with odds of receiving a non-NSM with reconstruction (OR 1.01 P = 0.48).


      NSM is under-utilized by low-volume breast surgeons. Understanding barriers to adoption is an is an opportunity to enhance patient-centered outcomes.


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