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A Pilot Study to Evaluate Nipple-Areolar Complex (NAC) Sparing Mastectomy
This study is ongoing, but not recruiting participants.
First Received: October 2, 2007   Last Updated: September 28, 2009   History of Changes
Sponsor: M.D. Anderson Cancer Center
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00539227
  Purpose

Primary Objectives:

  • To prospectively evaluate the feasibility of nipple-areolar complex (NAC) sparing mastectomy as an alternative procedure to skin-sparing mastectomy for patients with a diagnosis of breast cancer or who are at high risk for developing breast cancer, by measuring nipple sensation, cosmetic outcomes and complication rates.
  • To evaluate local recurrence rates and quality of life in patients undergoing of NAC-sparing mastectomy.
  • To further investigate which factors may be correlated with neoplastic NAC involvement, such as primary tumor size, concomitant DCIS, nuclear grade, histologic subtype, tumor distance from the NAC and overlying skin, and axillary lymph node involvement.

Condition Intervention
Breast Cancer
Procedure: NAC Sparing Mastectomy
Behavioral: Questionnaire

Study Type: Observational
Study Design: Case Control, Prospective
Official Title: A Pilot Study to Evaluate Nipple-Areolar Complex (NAC) Sparing Mastectomy

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Nipple Sensation Evaluation (following NAC sparing mastectomy) [ Time Frame: Within first month postoperatively, then at 3 months, 6 month, 1 year, 2 years, and 5 years postoperatively (each interval +/- 1 month) ] [ Designated as safety issue: No ]

Biospecimen Retention:   None Retained

Biospecimen Description:

Estimated Enrollment: 30
Study Start Date: October 2007
Estimated Primary Completion Date: April 2012 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
NAC Sparing Mastectomy Procedure: NAC Sparing Mastectomy
A skin-sparing mastectomy performed with preservation of the nipple-areolar complex (NAC).
Behavioral: Questionnaire
Questionnaires taking about 20-30 minutes to complete.

Detailed Description:

Operative Procedure:

You will have a skin-sparing mastectomy performed with preservation of the nipple-areolar complex (NAC). During surgery, the tissue will be tested while you are still under general anesthesia.

The NAC may be removed completely during the surgery if malignant cells are found during the testing done during the surgery or if suspicious cells that are not clearly benign cells are found. This will be up to your doctor. The NAC may also be removed surgically if the primary tumor is found to be located less than an inch from the border of the NAC, or you are found to have breast cancer with multiple "center" sites. The nipple can also be removed by itself, with the areola spared (this is called "areolar-sparing mastectomy") if your doctor is worried about its blood supply. These decisions will be made by your pathologist and treating surgeon.

You will then undergo immediate reconstruction, with either your own tissue, prosthetic tissue, or a combination of the two. This is up to your plastic surgeon. You will have met with your plastic surgeon before surgery to discuss the best reconstructive method for you, and you will be given an informed consent to sign at that time with details about the method you decide to use.

The breast tissue under the NAC will be biopsied and tested after your surgery. After that tissue has been tested, a second surgery may be needed if cancer cells are found, the tumor is too close to the NAC, or it has more than 1 "center" site. You will have the whole NAC removed in a separate operation. The place where the NAC was removed will be repaired by a plastic surgeon, who will choose the best method to get an acceptable cosmetic result. This may involve one or more extra surgeries, and you will be given separate informed consent documents to sign for each surgery.

Follow-up and Questionnaires:

If you agree to take part in this study, 4 sensory tests will be conducted on both breasts using a variety of hand-held devices. These tests are painless and will be performed at regularly scheduled follow-up visits in clinic. They will measure nipple and areolar sensitivity, as well as nipple erectibility. The tests will involve the placement of fibers of various thicknesses and blunt metal probes on the skin of your nipple and areola. All tests will be performed once before the surgery and then at about 3 months, 6 months, and 1 year after surgery, at your follow-up clinic visits.

Your breasts will be photographed at your 6-month and 1-year follow-up visits after surgery. At these visits, you will look at those photographs to decide how satisfied you are with how the breasts look. Two (2) plastic surgeons not directly involved in your surgery will also study those photographs by themselves and fill out a similar questionnaire rating their impression of the results of your plastic surgery. These results will not be made available to you. You will also complete a quality-of-life questionnaire within 1 month of your surgery, and then at 3 months, 6 months, 1 year, 2 years, and 5 years after surgery (+/- 1 month). The questionnaire will ask questions about nipple sensation, cosmetic outcomes, complications, and your quality of life. The questionnaire will take about 20-30 minutes to complete.

Length of Study:

You will remain on study for up to 5 years.

This is an investigational study. Up to 30 patients will take part in this study. All will be enrolled at M. D. Anderson.

  Eligibility

Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Patients with breast cancer.

Criteria

Inclusion Criteria:

  • Patients desiring prophylactic mastectomy with immediate reconstruction.
  • Patients with Stage 0, I, or II breast cancer who are candidates for and desire skin-sparing mastectomy with immediate reconstruction.
  • Tumor location greater than or equal to 2.5 cm from the border of the NAC based on preoperative imaging and/or clinical exam.
  • Patients must sign an informed consent and be registered before the procedure is performed.

Exclusion Criteria:

  • Patients with cancer involvement of the NAC on clinical exam, defined as induration, retraction, fixation, ulceration, or pathologic nipple discharge.
  • Patients with subareolar tumor locations, tumors located < 2.5 cm from the border of the NAC.
  • Patients with Paget's disease of the nipple.
  • Patients who have locally advanced breast cancer manifesting as inflammatory breast cancer or gross involvement of the mastectomy skin.
  • Patients with history of prior surgery involving a periareolar incision.
  • Patients desiring a concomitant ipsilateral reduction mammoplasty at time of mastectomy.
  • Patients with macromastia as defined by the plastic surgeon.
  • Patients with a body mass index (BMI) greater than 40 kg/m2.
  • Patients who actively smoke.
  • Patients with known collagen vascular disease.
  • Patients with prior ipsilateral chest wall irradiation less than 12 months from their time of surgery.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00539227

Locations
United States, Texas
U.T.M.D. Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Principal Investigator: Gildy V. Babiera, MD U.T.M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: U.T.M.D. Anderson Cancer Center ( Gildy V. Babiera, MD/Associate Professor )
Study ID Numbers: 2007-0194
Study First Received: October 2, 2007
Last Updated: September 28, 2009
ClinicalTrials.gov Identifier: NCT00539227     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by M.D. Anderson Cancer Center:
Breast Cancer
Nipple-Areolar Complex
Mastectomy
Prophylactic mastectomy
Immediate reconstruction
Reconstructive surgery
Questionnaire
Survey
NAC

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Site
Skin Diseases
Breast Neoplasms
Breast Diseases

ClinicalTrials.gov processed this record on November 27, 2009