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Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients

Abstract

Purpose

Women with mutations in breast cancer predisposition genes have a significantly higher lifetime risk of developing breast cancer and can opt for risk-reducing mastectomy. Women with positive family history of cancer can also opt for prophylactic surgery as a preventive method in selected cases. Current studies showed reduced risk of developing breast cancer after prophylactic nipple-sparing mastectomy, however, despite the good clinical outcomes, one of the main concerns regarding nipple-sparing mastectomy (NSM) is the oncological safety of nipple-areola complex preservation. In this study, we aimed to evaluate the indications, complication rates, and unfavorable events of 62 Brazilian patients that underwent risk-reducing NSM from 2004 to 2018.

Methods

Patient data were reviewed retrospectively and descriptive statistics were utilized to summarize the findings.

Results

The mean patients age was 43.8 years. The main indication for risk-reducing NSM was the presence of pathogenic mutation (53.3%), followed by atypia or lobular carcinoma in situ (25.8), and family history of breast cancer and/or ovarian cancer (20.9%). There were four (3.2%) incidental diagnosis of ductal carcinoma in situ and one invasive ductal carcinoma (0.8%). From the 124 prophylactic NSM performed, two (1.6%) complications had occurred: one (0.8%) infection and one (0.8%) partial nipple necrosis. In a mean follow-up of 50 months, there was one (1.6%) newly diagnosed breast cancer in the 62 patients undergoing prophylactic NSM.

Conclusions

Our findings demonstrated efficacy and safety to perform NSM as prophylactic surgery with good oncological outcomes and low complication rates in a case series of Brazilian patients.

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Data availability

All data analyzed during this study are included in this published article.

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Funding

The authors disclosure that they have no commercial interest in the subject of study and received no financial or material support for the study.

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation and writing the manuscript were performed by ALF, MAMRF, ABF, BV and FB; data collection, analysis and writing the manuscript were perfomed by ML and ABAS. The first draft of the manuscript was written by MLs and all authors commented on previous versions of the manuscript. Supervision was performed by ALF.

Corresponding author

Correspondence to Antônio Luiz Frasson.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards by the Institutional Ethics Committee of Pontifical Catholic University of Rio Grande do Sul (PUCRS), Hospital Albert Einstein and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective study) formal consent is not required.

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Frasson, A.L., Lichtenfels, M., de Souza, A.A.B. et al. Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients. Breast Cancer Res Treat 181, 69–75 (2020). https://doi.org/10.1007/s10549-020-05582-w

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Keywords

  • Prophylactic surgical procedures
  • Genetic predisposition to disease
  • Subcutaneous mastectomy
  • Breast neoplasm