Use of bilateral prophylactic nipple-sparing mastectomy in patients with high risk of breast cancer

Abstract

Background Nipple‐sparing mastectomy (NSM) is being performed increasingly for risk reduction in high‐risk groups. There are limited data regarding complications and oncological outcomes in women undergoing bilateral prophylactic NSM. This study reviewed institutional experience with prophylactic NSM, and examined the indications, rates of postoperative complications, incidence of occult malignant disease and subsequent breast cancer diagnosis. Methods Women who had bilateral prophylactic NSM between 2000 and 2016 were identified from a prospectively maintained database. Rates of postoperative complications, incidental breast cancer, recurrence and overall survival were evaluated. Results A total of 192 women underwent 384 prophylactic NSMs. Indications included BRCA1 or BRCA2 mutations in 117 patients (60·9 per cent), family history of breast cancer in 35 (18·2 per cent), lobular carcinoma in situ in 29 (15·1 per cent) and other reasons in 11 (5·7 per cent). Immediate breast reconstruction was performed in 191 patients. Of 384 NSMs, 116 breasts (30·2 per cent) had some evidence of skin necrosis at follow‐up, which resolved spontaneously in most; only 24 breasts (6·3 per cent) required debridement. Overall, there was at least one complication in 129 breasts (33·6 per cent); 3·6 and 1·6 per cent had incidental findings of ductal carcinoma in situ and invasive breast cancer respectively. The nipple–areola complex was preserved entirely in 378 mastectomies. After a median follow‐up of 36·8 months, there had been no deaths and no new breast cancer diagnoses. Conclusion These findings support the use of prophylactic NSM in high‐risk patients. The nipples could be preserved in the majority of patients, postoperative complication rates were low, and, with limited follow‐up, there were no new breast cancers.

Nipple Sparing Mastectomy as a Risk-Reducing Procedure for BRCA-Mutated Patients

“…None of the 63 patients in the study by Manning who underwent risk-reducing NACsparing mastectomy (median age: 39 years) at Memorial Sloan Kettering Cancer Center developed breast cancer at a follow-up of 2.5 years [18]. In a follow-up study from the same institution, Valero and colleagues reported that at a median follow-up of 36.8 months, there had been no new breast cancer diagnoses [21]. These results confirm the initial findings reported from De Alcantara Filho et al [20].…”

“…Nine studies met the inclusion criteria and were included in this review [13][14][15][16][17][18][19][20][21] (Figure 1). Two studies, from the same institution considered the same group of patients [20,21], and, therefore, only the one with longer follow-up [21] was included. Two studies were assessed as (Level of Evidence) LoE III and six studies as LoE IV, while the quality of the studies ranged from 5 to 7 (Table 1).…”

Trends and timing of risk-reducing mastectomy uptake in unaffected BRCA1 and BRCA2 carriers in Slovenia

“…The longest reported follow-up of 51 months in a cohort of 26 patients undergoing prophylactic SSM implies SSM is an oncologically safe procedure in BRCA carriers [35]. Compared to SSM, NSM Despite relatively short follow-ups and retrospective nature of these reports, NSM appears to be highly preventative against breast cancer in BRCA carriers while offering superior cosmetic outcomes [37,39,40] and is as such at present the preferred option for unaffected high-risk patients in our institution.…”

ASO Author Reflections: How Do We Improve Ergonomics for the Breast Surgeon During Nipple-Sparing Mastectomies?

“…[1][2][3] The mental and physical workload for these surgeries is significant. As the nipple-sparing mastectomy procedure becomes more prevalent, 4 we cannot help but wonder the toll this will take on the surgeon.…”