Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients

• Published in: Breast cancer research and treatment Vol. 181; no. 1; pp. 69 - 75
• Main Authors: Frasson, Antônio Luiz, Lichtenfels, Martina, de Souza, Alessandra Anton Borba, Vollbrecht, Betina, Falcone, Ana Beatriz, Frasson, Mônica Adriana Rodriguez Martinez, Barbosa, Fernanda
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2020; Springer; Springer Nature B.V
• Subjects: Adult; Brazil; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cancer research; Carcinoma, Ductal; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Clinical Trial; Development and progression; Family medical history; Female; Follow-Up Studies; Genetic aspects; Health aspects; Health risk assessment; Humans; Invasiveness; Mastectomy; Mastectomy - methods; Mastectomy - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Mutation; Nipples - pathology; Nipples - surgery; Oncology; Oncology, Experimental; Organ Sparing Treatments - adverse effects; Organ Sparing Treatments - methods; Ovarian cancer; Patients; Preservation; Prevention; Prognosis; Prophylactic Mastectomy - adverse effects; Prophylactic Mastectomy - methods; Retrospective Studies; Risk; Surgery; Brazil; Subcutaneous mastectomy; Prophylactic surgical procedures; Genetic predisposition to disease; Breast neoplasm
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-020-05582-w

Purpose
Women with mutations in breast cancer predisposition genes have a significantly higher lifetime risk of developing breast cancer and can opt for risk-reducing mastectomy. Women with positive family history of cancer can also opt for prophylactic surgery as a preventive method in selected cases. Current studies showed reduced risk of developing breast cancer after prophylactic nipple-sparing mastectomy, however, despite the good clinical outcomes, one of the main concerns regarding nipple-sparing mastectomy (NSM) is the oncological safety of nipple-areola complex preservation. In this study, we aimed to evaluate the indications, complication rates, and unfavorable events of 62 Brazilian patients that underwent risk-reducing NSM from 2004 to 2018.
Methods
Patient data were reviewed retrospectively and descriptive statistics were utilized to summarize the findings.
Results
The mean patients age was 43.8 years. The main indication for risk-reducing NSM was the presence of pathogenic mutation (53.3%), followed by atypia or lobular carcinoma in situ (25.8), and family history of breast cancer and/or ovarian cancer (20.9%). There were four (3.2%) incidental diagnosis of ductal carcinoma in situ and one invasive ductal carcinoma (0.8%). From the 124 prophylactic NSM performed, two (1.6%) complications had occurred: one (0.8%) infection and one (0.8%) partial nipple necrosis. In a mean follow-up of 50 months, there was one (1.6%) newly diagnosed breast cancer in the 62 patients undergoing prophylactic NSM.
Conclusions
Our findings demonstrated efficacy and safety to perform NSM as prophylactic surgery with good oncological outcomes and low complication rates in a case series of Brazilian patients.