Male Nipple-Sparing Mastectomy and Areolar-Sparing Mastectomy: A Multi-Institutional Retrospective Review of Indications and Outcomes

Introduction: Most male breast cancer is Treated With Total Mastectomy (TM), despite Nipple-Sparing Mastectomy (NSM) and Areolar-Sparing Mastectomy (ASM) being common in women for improved aesthetic outcomes. This study evaluates the indications for male NSM and ASM, and oncologic outcomes. Methods: A muti-institution retrospective review of male NSM and ASM during 2008-2023 at 5 institutions was performed. Indications, tumor characteristics, treatment and outcomes were analyzed. Results: 15 males, ages 36-77, underwent 11 NSM and 3 ASM for pTis, pT1-2, pN0-N2, ER+/PR+ invasive ductal carcinoma, 5/14(36%) HER2 positive of which 3 received neoadjuvant chemotherapy. For BRCA1 mutations, a prophylactic bilateral NSM and 1 contralateral NSM resulted in 14 NSM total. Indications for NSM were no clinical nipple involvement (imaging and physical exam), and the ability to obtain clear margins. ASM indications were cancer close to the nipple (n=2) and removal for margins, or positive sub-nipple biopsy (n=1), allowing for areola preservation away from cancer and closure of areola to create appearance of a nipple. All ASM were satisfied with appearance, declining reconstruction. Following NSM, delayed fat grafting in 2/13(15%) resulted in excellent appearance. Pathology showed one pCR, pTis, pT1-T2, pN0-N2, largest tumor size 3.2 cm, and clear margins in all. Two patients (14%) with pN1-pN2 received postoperative radiotherapy. No recurrences or contralateral cancers at 8.8 years mean follow-up. Conclusion: NSM and ASM are alternatives to TM for males. In this first reported multi-institution series, the oncologic outcomes are excellent, aesthetics appears improved compared to TM, without any local recurrences to date.