Vol.:(0123456789)
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Breast Cancer Research and Treatment (2018) 171:427–434
https://doi.org/10.1007/s10549-018-4830-y
EPIDEMIOLOGY
Evolving surgical treatment decisions for male breast cancer:
an analysis of the National Surgical Quality Improvement Program
(NSQIP) database
Maryam Elmi
1,2,5
· Sangita Sequeira
1
· Arash Azin
1
· Ahmad Elnahas
4
· David R. McCready
1,2
· Tulin D. Cil
1,2,3
Received: 13 May 2018 / Accepted: 19 May 2018 / Published online: 28 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Background Male breast cancer (MBC) is a rare malignancy, and gender-specific treatment outcomes are currently lacking.
The use of a large, multi-national surgical-outcomes database may provide a better understanding of treatment patterns and
postoperative morbidity in men who undergo oncological breast surgery.
Methods A retrospective cohort analysis was conducted between 2007 and 2016 using the American College of Surgeons
National Surgical Quality Improvement Program database (NSQIP), examining MBC treatment patterns and postoperative
complication rates. All men undergoing surgery for the treatment of invasive or in situ carcinoma of the breast were identified.
Clinical characteristics, demographics, and surgical treatment options most frequently used for this population were described.
In addition, the 30-day postoperative complication rates in the surgical treatment of male breast cancer were evaluated.
Results A total of 1773 MBC patients with a median age of 65 years (IQR 56–74 years) were included in this analysis. Mean
body mass index (BMI) was 29.1 (IQR 25.4–33.8). In this study population, 177 (10.0%) had a diagnosis of in situ breast
cancer, while the remaining 1596 (90.0%) had invasive disease. While most men underwent mastectomy, 282 (15.9%) had
breast-conserving surgery. There were 74 (4.2%) patients who underwent immediate breast reconstruction. In addition, 118
(6.7%) patients elected to have a contralateral prophylactic mastectomy. Overall, the rate of morbidity was 4.6%, comprising
mostly of wound complications (3.2%).
Conclusion Analysis of this large, prospective multi-institutional cohort revealed that complication rates are low and com-
parable to reported rates in the female breast cancer population. What is also significant about this analysis is that the
cohort demonstrated the importance of cosmetic considerations in MBC patients, as some men decide to undergo breast-
conserving surgery or immediate breast reconstruction. Contralateral prophylactic mastectomy in the treatment of MBC is
also performed.
Keywords Male breast cancer · National Surgical Quality Improvement Program · Surgical management of cancer · Male
breast reconstruction · Male breast-conserving surgery
Introduction
Male breast cancer (MBC) is a rare malignancy, accounting
for 1% of all breast cancers [1]. Although there is a paucity
of data on MBC patients, the incidence of MBC is on the
Poster Presentation: Annual Scientific Meeting, American Society
of Breast Surgeons, Orlando, Florida, USA, May 2–8 2018.
* Maryam Elmi
maryam.elmi@utoronto.ca
1
Department of Surgery, University of Toronto, Toronto, ON,
Canada
2
Division of General Surgery, University Health Network,
Toronto, ON, Canada
3
Department of Surgery, Women’s College Hospital, Toronto,
ON, Canada
4
Department of Surgery, Western University, London, ON,
Canada
5
UT Texas Health San Antonio MD Anderson Cancer Center,
San Antonio, TX, USA
@Phil_Robichaud
@deepthiw
@JoseServera