. 2016 May 20;6(5):e010151. doi: 10.1136/bmjopen-2015-010151

Table 1.

Prior reviews of nipple sparing mastectomy

Review	Databases included and years searched	Studies/patients included	Key findings
Zhang et al 2015¹⁸	PubMed, 1978–2014	27 studies, 7971 patients	‘Owing to the statistical heterogeneity detected with certain parameters, further investigations to confirm their association with nipple involvement [NI] will be needed. Patients with one or more risk factors such as centrally located tumours; higher tumour stage; large tumours; ER negative/PR negative/HER positive status and associated DCIS have higher risk of NI. Taking these factors into consideration comprehensively may help with decision-making process for NSM.’
Piper et al 2013¹⁹	MEDLINE and Cochrane databases, inception to Nov 2011	27 studies, 3331 mastectomies	‘Review of oncological outcomes in the 10 studies (representing 1148 mastectomies) with documented mean/median follow-up of 2 years demonstrated an overall locoregional recurrence rate of 2.8%. Ischaemic complications involving the NAC were reported in 24 studies (representing 3091 mastectomies), with 9.1% of cases reported to have some degree of NAC necrosis and 2.0% of cases complicated by complete necrosis leading to NAC loss. Sixteen studies (representing 2213 mastectomies) reported rates of skin flap necrosis, which occurred in 9.5% of cases.’
Endara et al 2013²⁰	PubMed and Ovid databases, 1970 to 1 January 2013	48 studies, 5166 patents	‘Nipple sparing mastectomy appears to be an oncologically safe option for properly selected patients, with low rates of locoregional and distant metastasis. Overall complication and nipple necrosis rates are affected by incision location and reconstruction method.’
De La Cruz et al 2015²¹	MEDLINE, Scopus, Google Scholar from 1967-Jan 2015	20 studies, 5594 patients	Adverse oncological outcomes of NSM in carefully selected women with early stage breast cancer were not detected.

DCIS, ductal carcinoma in situ; ER, estrogen-receptor; HER, human epidermal growth factor receptor; NAC, nipple-areola complex; NI, nipple involvement; NSM, nipple sparing mastectomy; PR, progesterone receptor.