Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: An Interim Analysis and Review of the Literature
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There are few large-scale studies that have examined outcomes for BRCA1/2 carriers who have undergone nipple-sparing mastectomy (NSM). The objective of our study was to examine incidental cancers, operative complications, and locoregional recurrences in BRCA1/2 mutation carriers who underwent NSM for both risk reduction and cancer treatment.
This was a retrospective review of pathology results and outcomes of 201 BRCA1/2 carriers from two different institutions who underwent NSM from 2007 to 2014.
NSM was performed in 397 breasts of 201 BRCA1/2 carriers. One hundred and twenty-five (62.2 %) patients had a BRCA1 mutation and 76 (37.8 %) had a BRCA2 mutation; 150 (74.6 %) patients underwent NSM for risk reduction and 51 (25.4 %) for cancer. Incidental cancers were found in four (2.7 %) of the 150 risk-reduction patients and two (3.9 %) of the 51 cancer patients. The nipple-areolar complex (NAC) was involved with cancer in three (5.8 %) patients. No prophylactic mastectomy had a positive NAC margin. There was loss of the NAC in seven breasts (1.8 %) and flap necrosis in ten (2.5 %) breasts. With a mean follow-up of 32.6 months (1–76 months), there have been four cancer events—three in cancer patients and one in a risk-reduction patient but none at the NAC.
NSM in BRCA1/2 carriers is associated with a low rate of complications and locoregional recurrence but these patients require long-term follow-up in both the cancer and risk-reduction setting.
KeywordsLocoregional Recurrence Nipple Massachusetts General Hospital Contralateral Breast Cancer Prophylactic Mastectomy
The authors acknowledge the Auxiliary of Evanston and Glenbrook Hospitals ACE Breast Research Fund for their generous support of this project through the breast research fellowship program.
Katharine Yao, Erik Liederbach, Rong Tang, Lan Lei, Tomasz Czechura, Mark Sisco, Michael Howard, Peter J. Hulick, David J. Winchester, Suzanne B. Coopey, and Barbara L. Smith do not have any financial or commercial interests to disclose.
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