Annals of Surgical Oncology

, 18:3102 | Cite as

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

  • Carol Reynolds
  • Jennifer A. Davidson
  • Noralane M. Lindor
  • Katrina N. Glazebrook
  • James W. Jakub
  • Amy C. Degnim
  • Nicole P. Sandhu
  • Molly F. Walsh
  • Lynn C. Hartmann
  • Judy C. Boughey
American Society of Breast Surgeons

Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

Notes

Acknowledgment

I (C.R.) would like to acknowledge and extend my heartfelt gratitude to Dr. David L. Page, Vanderbilt University, for his inspiration in this work and his encouragement and support over the years.

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Carol Reynolds
    • 1
  • Jennifer A. Davidson
    • 1
  • Noralane M. Lindor
    • 2
  • Katrina N. Glazebrook
    • 3
  • James W. Jakub
    • 4
  • Amy C. Degnim
    • 4
  • Nicole P. Sandhu
    • 5
  • Molly F. Walsh
    • 6
  • Lynn C. Hartmann
    • 7
  • Judy C. Boughey
    • 4
  1. 1.Department of PathologyMayo Clinic, Division of Anatomic PathologyRochesterUSA
  2. 2.Department of Medical GeneticsMayo ClinicRochesterUSA
  3. 3.Department of Diagnostic RadiologyMayo ClinicRochesterUSA
  4. 4.Department of SurgeryMayo ClinicRochesterUSA
  5. 5.Department of General Internal MedicineMayo ClinicRochesterUSA
  6. 6.Division of Plastic SurgeryMayo ClinicRochesterUSA
  7. 7.Department of Medical OncologyMayo ClinicRochesterUSA

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