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Oncologic Safety of Nipple-Sparing Mastectomy for Breast Cancer in BRCA Gene Mutation Carriers: Outcomes at 70 Months Median Follow-Up

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Retention of the nipple–areola complex with nipple-sparing mastectomy (NSM) techniques provides a more natural cosmetic result than procedures that sacrifice the nipple. While the oncologic safety of NSM is established by several studies, there is little long-term data on outcomes in BRCA mutation carriers with breast cancer.

Patients and Methods

BRCA1/2 mutation carriers who underwent NSM and immediate reconstruction from 2008 to 2019 were reviewed and patients with breast cancer on biopsy or final pathology were included. Patient demographics and tumor characteristics, as well as treatment, recurrence, and survival data were collected.

Results

A total of 114 therapeutic NSM were performed in 105 BRCA mutation carriers (56 BRCA1, 47 BRCA2, and two women with both mutations). Median age was 45 years. Cancers were 18% stage 0, 52% stage I, 27% stage II, and 3% stage III. Mean invasive tumor size was 1.6 cm and 33 (35%) invasive tumors were triple negative. There were five (4.4%) positive nipple margins on final pathology; all underwent nipple excision. Most patients (80, 76%) received systemic therapy: 65 (62%) received chemotherapy and 48 (46%) received endocrine therapy. At 70 months median follow-up (range 15–150 months), no patient had developed a recurrence in the retained nipple–areola complex or at the site of a nipple excised for a positive margin. The rate of locoregional recurrence outside the nipple was 2.6%, and the rate of distant recurrence was 3.8%. Overall survival was 96%.

Conclusions

NSM is a safe option for BRCA1 and BRCA2 mutation carriers who undergo mastectomy for breast cancer.

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Acknowledgement

We gratefully acknowledge the support of the Susan and Michael Schechter Research Fund and the Massachusetts General Hospital Breast Surgery Endowed Fellowship Fund for this study.

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Authors and Affiliations

  1. Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Alexandra J. Webster BS, Julia N. Shanno BS, Heidi S. Santa Cruz BA, Bridget N. Kelly BA, Meghan Garstka MD, MS, Anthony Henriquez AB, Michelle C. Specht MD, Michele A. Gadd MD, Francys C. Verdial MD, MPH, Anvy Nguyen MD, Tawakalitu O. Oseni MD, Suzanne B. Coopey MD & Barbara L. Smith MD, PhD

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  1. Alexandra J. Webster BS
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  2. Julia N. Shanno BS
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Correspondence to Barbara L. Smith MD, PhD.

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Webster, A.J., Shanno, J.N., Santa Cruz, H.S. et al. Oncologic Safety of Nipple-Sparing Mastectomy for Breast Cancer in BRCA Gene Mutation Carriers: Outcomes at 70 Months Median Follow-Up. Ann Surg Oncol 30, 3215–3222 (2023). https://doi.org/10.1245/s10434-022-13006-w

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