Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: An Interim Analysis and Review of the Literature

An Erratum to this article was published on 05 August 2014



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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  1. 1.

    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.

    PubMed  Article  Google Scholar 

  2. 2.

    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.

    PubMed  Article  Google Scholar 

  3. 3.

    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.

    PubMed  Article  Google Scholar 

  4. 4.

    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.

    PubMed Central  PubMed  Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    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.

    PubMed  Article  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    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.

    PubMed  Article  Google Scholar 

  9. 9.

    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.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    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.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. 11.

    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.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  12. 12.

    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.

    PubMed  Article  Google Scholar 

  13. 13.

    Metcalfe K, Lynch HT, Ghadirian P, et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2004;22:2328–2335.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    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.

    Article  Google Scholar 

  15. 15.

    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.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    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.

    PubMed  Article  Google Scholar 

  17. 17.

    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.

    PubMed Central  PubMed  Article  Google Scholar 

  18. 18.

    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.

    PubMed  Article  Google Scholar 

  19. 19.

    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.

    PubMed  Article  Google Scholar 

  20. 20.

    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.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Spear SL, Willey SC, Feldman ED, et al. Nipple-sparing mastectomy for prophylactic and therapeutic indications. Plast Reconstr Surg.2011;128:1005–1014.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    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.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    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.

  24. 24.

    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.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    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.

    PubMed  Article  Google Scholar 

  26. 26.

    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.

    PubMed  Article  Google Scholar 

  27. 27.

    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.

  28. 28.

    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.

    PubMed  Article  Google Scholar 

  29. 29.

    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.

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    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.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20:3218–3222.

    PubMed  Article  Google Scholar 

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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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Correspondence to Katharine Yao MD.

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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).

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  • Locoregional Recurrence
  • Nipple
  • Massachusetts General Hospital
  • Contralateral Breast Cancer
  • Prophylactic Mastectomy