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

• Published in: British journal of surgery Vol. 107; no. 10; pp. 1307 - 1312
• Main Authors: Valero, M G, Moo, T-A, Muhsen, S, Zabor, E C, Stempel, M, Pusic, A, Gemignani, M L, Morrow, M, Sacchini, V
• Format: Journal Article
• Language: English
• Published: Chichester, UK Oxford University Press 01-09-2020; John Wiley & Sons, Ltd
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - genetics; Breast Neoplasms - prevention & control; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - diagnosis; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - diagnosis; Carcinoma, Intraductal, Noninfiltrating - surgery; Carcinoma, Lobular - diagnosis; Carcinoma, Lobular - surgery; Female; Follow-Up Studies; Genes, BRCA1; Genes, BRCA2; Genetic Predisposition to Disease; Humans; Incidental Findings; Mammaplasty; Mastectomy; Middle Aged; Mutation; Nipples; Organ Sparing Treatments; Original; Postoperative Complications; Prophylactic Mastectomy; Retrospective Studies; Young Adult
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11616

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.
Graphical Abstract
This study reviewed an institutional experience with prophylactic nipple-sparing mastectomy, and examined the indications, rates of postoperative complications, incidence of occult malignant disease and subsequent breast cancer diagnosis. This institutional experience supports the use of prophylactic nipple-sparing mastectomy in high-risk patients.
Graphical Abstract
Safe option