American Society of Breast Surgeons

Annals of Surgical Oncology

, Volume 18, Issue 11, pp 3102-3109

First online:

Prophylactic and Therapeutic Mastectomy in BRCA Mutation Carriers: Can the Nipple Be Preserved?

  • Carol ReynoldsAffiliated withDepartment of Pathology, Mayo Clinic, Division of Anatomic Pathology Email author 
  • , Jennifer A. DavidsonAffiliated withDepartment of Pathology, Mayo Clinic, Division of Anatomic Pathology
  • , Noralane M. LindorAffiliated withDepartment of Medical Genetics, Mayo Clinic
  • , Katrina N. GlazebrookAffiliated withDepartment of Diagnostic Radiology, Mayo Clinic
  • , James W. JakubAffiliated withDepartment of Surgery, Mayo Clinic
  • , Amy C. DegnimAffiliated withDepartment of Surgery, Mayo Clinic
  • , Nicole P. SandhuAffiliated withDepartment of General Internal Medicine, Mayo Clinic
  • , Molly F. WalshAffiliated withDivision of Plastic Surgery, Mayo Clinic
  • , Lynn C. HartmannAffiliated withDepartment of Medical Oncology, Mayo Clinic
    • , Judy C. BougheyAffiliated withDepartment of Surgery, Mayo Clinic

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Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers.


Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple–areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted.


Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct.


The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10%) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24% of NACs contained TDLUs, with only 8% found in the nipple papilla; the significance of this for long-term risk is unknown.