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

Abstract

Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.

Surgical Management of Inherited Breast Cancer: Role of Breast-Conserving Surgery

“…Indeed, Muller et al recently underlined the extremely low risk of cancer development following breast risk-reducing surgery as follows: specifically, out of 3716 cases of prophylactic NSMs, only 9 cases (0.2%) of BC exterior to the nipple-areola complex (NAC) and 1 case (0.004%) of BC within the NAC were reported [60]. To date, NSM appears to be a safe risk-reduction procedure for BRCA mutation carriers from an oncological point of view, as highlighted in a recent literature review, which reported low rates of new BCs, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life [61].…”

Hereditary Breast and Ovarian Cancer: A Review of Genetic Testing and Management of High-Risk Patients

“…The choice of nipple-sparing mastectomy (NSM) versus simple mastectomy is an individualized decision that requires shared decision-making between the surgeon and the patient. A recent review of NSM in BRCA1/2 mutation carriers reported that NSM is a safe option for RRM, with low rates of new breast cancer on the side of prophylactic surgery and postoperative complications 15. There is no benefit to adjunctive chemoprevention after risk-reducing surgery and no compelling evidence exists to support continued surveillance with mammography or MRI after RRM.…”

Surgical Management of Hereditary Breast Cancer

“…This has been the largest series of prophylactic NSM in BRCA carriers in the literature to date and, although follow-up remains short, the cumulative evidence supports NSM as an appropriate risk-reducing procedure for patients with genetic variants. A review by Lewis et al and Rocco et al discussed and demonstrated the safety of NSM in genetic variant carriers [ 79 , 80 ].…”