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.
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de Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–3122.
Wagner JL, Fearmonti R, Hunt KK, et al. Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early stage breast cancer. Ann Surg Oncol. 2012;19:1137–1144.
Jensen JA, Orringer JS, Giuliano AE. Nipple sparing mastectomy in 99 patients with a mean follow up of 5 years. Ann Surg Oncol. 2011;18:1665–1670.
Harness JK, Vetter TS, Salibian AH. Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol. 2011;18:917–922.
Crowe JP, Patrick RJ, Yetman RJ, Djohan R. Nipple sparing mastectomy update: one hundred forty nine procedures and clinical outcomes. Arch Surg. 2008; 146:1106–1110.
Warren Peled A, Foster RD, Stover AC, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012; 19:3402–3409.
Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow up study. Ann Surg Oncol. 2009;249:461–468.
Kim HJ, Park EH, Lim WS, et al. Nipple areola skin sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure. Ann Surg. 2010;251:493–498.
Benediktsson KP, Perbeck L. Survival in breast cancer after nipple sparing subcutaneous mastectomy with immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008;34:143–148.
Kurian AW, Sigal BM, Plevritis SK. Survival analysis of cancer risk reduction strategies for BRCA 1 and 2 mutation carriers. J Clin Oncol. 2010;28:222–231.
Antoniou A, Pharoah P, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA 1 and BRCA 2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72:1117–1130.
Pierce LJ, Levin AM, Rebbeck TR, et al. Ten year multi-institutional results of breast conserving surgery and radiotherapy in BRCA1 and 2 associated stage I and II breast cancer. J Clin Oncol. 2006;24:2437–2443.
Metcalfe K, Lynch HT, Ghadirian P, et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2004;22:2328–2335.
Hartman LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–84.
Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159–164.
Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2004;22:1055–1062.
Heemskerk-Gerritsen, Brekelmans CT, Menke-Pluymers MB, et al. Prophylactic mastectomy in BRCA 1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg Oncol. 2007;14:3335–3344.
Reynolds C, Davidson JA, Lindor NM, et al. Prophylactic and therapeutic mastectomy in BRCA mutation carriers: can the nipple be preserved? Ann Surg Oncol. 2011;18:3102–3109.
Peled AW, Irwin CS, Hwang ES, Ewing CA, Alvarado M, Esserman LJ. Total skin-sparing mastectomy in BRCA mutation carriers. Ann Surg Oncol. 2014;21:37–41.
Colwell AS, Tessler O, Lin AM, et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg. 2014;133:496–506.
Spear SL, Willey SC, Feldman ED, et al. Nipple-sparing mastectomy for prophylactic and therapeutic indications. Plast Reconstr Surg.2011;128:1005–1014.
Algaithy ZK, Petit JY, Lohsiriwat V, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012;38:125–129.
Hartman LC, SellersTA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93:1633–1637.
Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304:967–975.
Sacchini V, Pinotti JA, Barros AC, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203:704–714.
Billar JA, Dueck AC, Gray RJ, Wasif N, Pockaj BA. Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer. Ann Surg Oncol. 2011;18:3123–3128.
Stanec Z, Zic R, Budi S, et al. Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience. Ann Plast Surg. Epub 25 Dec 2013.
Brachtel EF, Rusby JE, Michaelson JS, et al. Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol. 2009;27:4948–4954.
Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol. 1999;6:676–681.
Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2009;114:97–101.
Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–3222.
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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Yao, K., Liederbach, E., Tang, R. et al. Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: An Interim Analysis and Review of the Literature. Ann Surg Oncol 22, 370–376 (2015). https://doi.org/10.1245/s10434-014-3883-3
- Locoregional Recurrence
- Massachusetts General Hospital
- Contralateral Breast Cancer
- Prophylactic Mastectomy