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Use of Mammographic Measurements to Predict Complications After Nipple-Sparing Mastectomy in BRCA Mutation Carriers

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is limited data evaluating mastectomy skin flap complications of nipple-sparing mastectomy (NSM) in patients with BRCA gene mutations. The purpose of this study was to identify factors associated with post-operative complications in BRCA mutation carriers undergoing NSM.

Methods

Following institutional review board approval, we interrogated a prospectively collected institutional database for patients undergoing NSM who tested positive for BRCA1/2 mutations. Patient characteristics, preoperative details, and complications were evaluated. Digital mammogram was used to estimate the breast volume.

Results

From August 2009 to December 2017, 59 patients (2 males) with BRCA1/2 mutations underwent 114 NSMs. Ninety-two (80%) were risk-reduction surgeries. Thirty-two (28%) underwent single-stage reconstruction (24 autologous). The overall complication rate was 26.3% (N = 30), and 10.5% (N = 12) underwent unanticipated reoperation. 8.8% (N = 10) had full-thickness skin flap necrosis, 10.5% (N = 12) nipple necrosis, and 4.4% (N = 5) full-thickness nipple necrosis. These complications were associated with larger breast volume (799.4 cc vs. 544.1 cc, p < 0.001) and greater body mass index (27.8 vs. 24.3, p < 0.001). By univariate analysis, body mass index and breast volume greater than 675 cc were associated with significantly higher complication rate (odds ratios 1.2 and 4.5 respectively, p = 0.001).

Conclusions

This study confirms that NSM in BRCA1/2 mutation carriers is associated with complications in one in four patients. Utilizing the preoperative mammograms to estimate breast size may be more helpful than breast cup size in counseling preoperatively the risks of complications.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ko Un Park MD

  2. Department of Surgical Oncology, Brigham and Women’s Hospital, Boston, MA, USA

    Anna Weiss MD

  3. Department of Surgical Oncology, Banner MD Anderson, Gilbert, AZ, USA

    Kelly Rosso MD

  4. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Min Yi MD, PhD, Kelly Hunt MD & Henry Kuerer MD, PhD

  5. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Summer E. Hanson MD

  6. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rosalind Candelaria MD

  7. Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, USA

    Sarah Tevis MD

  8. Department of Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, TX, USA

    Alastair Thompson MD

Authors
  1. Ko Un Park MD
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  2. Anna Weiss MD
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  3. Kelly Rosso MD
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  4. Min Yi MD, PhD
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  5. Kelly Hunt MD
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  6. Henry Kuerer MD, PhD
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  7. Summer E. Hanson MD
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  9. Sarah Tevis MD
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  10. Alastair Thompson MD
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Correspondence to Ko Un Park MD.

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Park, K.U., Weiss, A., Rosso, K. et al. Use of Mammographic Measurements to Predict Complications After Nipple-Sparing Mastectomy in BRCA Mutation Carriers. Ann Surg Oncol 27, 367–372 (2020). https://doi.org/10.1245/s10434-019-07704-1

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  • DOI: https://doi.org/10.1245/s10434-019-07704-1

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