Total Skin-Sparing Mastectomy in BRCA Mutation Carriers
- 28 August 2013
- journal article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 21 (1), 37-41
- https://doi.org/10.1245/s10434-013-3230-0
Abstract
Total skin-sparing mastectomy (TSSM) with preservation of the nipple–areolar complex skin has become increasingly accepted as an oncologically safe procedure. Oncologic outcomes after TSSM in BRCA mutation carriers have not been well-studied. We identified 53 BRCA-positive patients who underwent bilateral TSSM for prophylactic (26 patients) or therapeutic indications (27 patients) from 2001 to 2011. Cases were age-matched (for prophylactic cases) or age- and stage-matched (for therapeutic cases) with non-BRCA-positive patients. Outcomes included tumor involvement of resected nipple tissue, the development of new breast cancers in patients who underwent risk-reducing TSSM, and local–regional recurrence in patients who underwent therapeutic TSSM. Outcomes from 212 TSSM procedures in 53 cases and 53 controls were analyzed. In patients undergoing TSSM for prophylactic indications, in situ cancer was found in one (1.9 %) nipple specimen in BRCA-positive patients versus two specimens (3.8 %) in the non-BRCA-positive cohort (p = 1). At a mean follow-up of 51 months, no new cancers developed in either cohort. In patients undergoing TSSM for therapeutic indications, in situ or invasive cancer was found in zero of the nipple specimens in BRCA-positive patients versus two specimens (3.7 %) in the non-BRCA-positive cohort (p = 0.49). At a mean follow-up of 37 months, there were no local–regional recurrences in the BRCA-positive cohort and 1 (3.7 %) in the non-BRCA-positive cohort. TSSM is an oncologically safe procedure in BRCA-positive patients. In patients undergoing TSSM as a risk-reducing strategy, 4-year follow-up demonstrates no increased risk of developing new breast cancers; longer-term follow-up is ongoing.Keywords
This publication has 17 references indexed in Scilit:
- Reducing the Risk of Nipple Necrosis: Technical Observations in 340 Nipple-sparing MastectomiesThe Breast Journal, 2013
- Nipple sparing mastectomy: Can we predict the factors predisposing to necrosis?European Journal of Surgical Oncology, 2012
- Prophylactic and Therapeutic Mastectomy in BRCA Mutation Carriers: Can the Nipple Be Preserved?Annals of Surgical Oncology, 2011
- Nipple-Sparing Mastectomy for Breast Cancer and Risk-Reducing Surgery: The Memorial Sloan-Kettering Cancer Center ExperienceAnnals of Surgical Oncology, 2011
- Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and MortalityJama-Journal Of The American Medical Association, 2010
- Patient Satisfaction following Nipple-Sparing Mastectomy and Immediate Breast Reconstruction: An 8-Year Outcome Study [Outcomes Article]Plastic and Reconstructive Surgery, 2010
- Nipple-Sparing Mastectomy: Initial Experience at the Memorial Sloan-Kettering Cancer Center and a Comprehensive Review of LiteratureThe Breast Journal, 2009
- Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?Breast Cancer Research and Treatment, 2008
- Technical Considerations in Nipple-Sparing Mastectomy: 82 Consecutive Cases without NecrosisAnnals of Surgical Oncology, 2008
- Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction: Oncologic or Technical Problem?Journal of the American College of Surgeons, 2006