Nipple-sparing mastectomy shows significant 2.1% pooled risk difference in overall survival over standard mastectomyNipple-Sparing Mastectomy Shows Good Long-Term Survival for Breast Cancer

Annals of surgical oncology Published November 3, 2026 Study authors: Rohrich Rachel N, Soltani Hannah, Snee Isabel, Fan Kenneth L, Lesnikoski Beth-Ann, De La Cruz Lucy M PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that nipple-sparing mastectomy is associated with significant overall survival and low recurrence rates comparable to standard mastectomy.

This meta-analysis synthesized data from 60 studies involving 7752 patients to compare nipple-sparing mastectomy (NSM) against skin-sparing mastectomy (SSM) and modified radical mastectomy (MRM). The analysis focused on survival outcomes and recurrence rates to evaluate the oncologic safety of NSM.

The primary finding was a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM for overall survival (95% CI 0.0-4.3%, p = 0.047). Among the subset of 391 patients with 10 years of follow-up, the survival rate was 82.0%. Other outcomes, including disease-free survival (4.8% risk difference, 95% CI -0.8 to 10.3%, p = 0.093) and local recurrence (-0.7% risk difference, 95% CI -2.1 to 0.8%, p = 0.35), did not reach statistical significance. The nipple-areolar complex recurrence rate was reported as low at 1.1% (95% CI 1.0-1.1%) among patients with 10 years of follow-up.

Clinically, these results suggest that NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM or MRM. The findings support the oncologic safety of NSM for appropriately selected patients. Limitations regarding the specific study designs and individual study qualities were not reported.

How this fits prior evidence

This meta-analysis addresses a gap in the clinical comparison of surgical techniques for breast cancer. While previous coverage has focused on diagnostic accuracy using AI and radiomics, and the efficacy of neoadjuvant therapies, this finding provides evidence on the surgical management of patients post-neoadjuvant treatment. It confirms that NSM provides comparable oncologic outcomes to traditional mastectomy techniques, supporting its use in patients who may have undergone neoadjuvant therapies like the antibody-drug conjugates mentioned in previous coverage.

A large meta-analysis looked at 7,752 patients who underwent a nipple-sparing mastectomy (NSM) for breast cancer. The study compared these results to other common procedures, such as skin-sparing mastectomy and modified radical mastectomy. The goal was to see if keeping the nipple and areola affected long-term health outcomes.

The findings showed a small but significant link between nipple-sparing surgery and better overall survival compared to other methods. Other measures, such as disease-free survival and local recurrence rates, were similar between the different types of surgery. Specifically, the rate of recurrence in the nipple-areolar complex was very low at 1.1% among patients followed for at least 10 years.

Because this was a meta-analysis of existing studies, the results show an association rather than a direct cause. The study suggests that for the right patients, nipple-sparing surgery is a safe option with low recurrence rates. You should talk to your surgical team to see if this specific approach is right for your personal health needs.

What this means for you:

Nipple-sparing mastectomy shows long-term survival and low recurrence rates similar to other mastectomy types.

Common questions

Is nipple-sparing mastectomy safe for breast cancer patients?

The study of 7,752 patients suggests that nipple-sparing mastectomy is associated with excellent long-term survival and low recurrence rates. These results were comparable to other types of mastectomy, such as skin-sparing or modified radical mastectomy. You should discuss your specific surgical options and safety with your doctor.

What is the risk of cancer returning in the nipple area?

The study reported a very low recurrence rate for the nipple-areolar complex. Among the patients followed for at least 10 years, the recurrence rate in that specific area was only 1.1%.

How does nipple-sparing surgery compare to other mastectomy types?

The analysis found that nipple-sparing mastectomy showed a 2.1% risk difference favoring it over other methods for overall survival. Other outcomes, like disease-free survival and local recurrence, were not significantly different between the types of surgery.

Study Details

Study typeMeta analysis

Sample sizen = 391

EvidenceLevel 1

Follow-up120.0 mo

PublishedNov 2026

PMID42252358

View Original Abstract ↓

BACKGROUND: Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update on oncologic outcomes following NSM, including overall survival (OS), disease-free survival (DFS), local recurrence (LR), and nipple-areolar complex recurrence (NACR). PATIENTS AND METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review identified studies reporting oncologic outcomes after NSM. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in the meta-analysis. Studies lacking comparison arms were included in pooled analyses for NSM outcomes using a random-effects model. Weighted averages and 95% confidence intervals (CI) were calculated, and studies were stratified by duration of follow-up. RESULTS: A total of 60 studies comprising 7752 NSM patients were included: 11 studies had comparison arms; 9 studies reporting OS demonstrated a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM (95% CI 0.0-4.3%, p = 0.047); 7 studies reporting DFS showed a nonsignificant pooled risk difference of 4.8% favoring NSM (95% CI -0.8 to 10.3%, p = 0.093); 11 studies reporting LR demonstrated a nonsignificant pooled risk difference of -0.7% (95% CI -2.1 to 0.8%, p = 0.35). The systematic review included all 60 studies. Weighted average follow-up ranged from 25.6 to 133.4 months across groups. Among patients with 10 years of follow-up (n = 391), OS was 82.0% (80.9-93.2%), DFS 60.7% (58.8-62.7%), LR 15.1% (13.9-16.2%), and NACR 1.1% (1.0-1.1%). CONCLUSIONS: NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM/MRM, with minimal NAC recurrence in appropriately selected patients, supporting its long-term oncologic safety.

Nipple-sparing mastectomy shows significant 2.1% pooled risk difference in overall survival over standard mastectomyNipple-Sparing Mastectomy Shows Good Long-Term Survival for Breast Cancer

How this fits prior evidence

Common questions

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Nipple-sparing mastectomy shows significant 2.1% pooled risk difference in overall survival over standard mastectomyNipple-Sparing Mastectomy Shows Good Long-Term Survival for Breast Cancer

How this fits prior evidence

Common questions

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Study Details

Platinum agents, PARP inhibitors, and immune checkpoint inhibitors increase pCR rates in early-stage TNBC

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