Nipple-sparing mastectomy in patients with<i>BRCA1/2</i>mutations and variants of uncertain significance

Manning, Aidan; Wood, C.; Eaton, Anne; Stempel, Michelle; Capko, Deborah; Pusic, Andrea L.; Morrow, Monica; Sacchini, Virgilio

doi:10.1002/bjs.9884

Cited by 77 publications

(43 citation statements)

References 20 publications

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“…Here, nipple–areola complexes were preserved entirely in 378 mastectomies; only three required nipple excisions secondary to some degree of nipple–areola complex necrosis. The rate of nipple–areola complex necrosis in this study supports the premise that NSM can be performed with a low rate of necrosis similar to that reported in the literature.…”

Section: Discussionsupporting

confidence: 90%

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

Valero¹,

Moo²,

Muhsen³

et al. 2020

British Journal of Surgery

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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.

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Section: Discussionsupporting

confidence: 90%

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

Valero¹,

Moo²,

Muhsen³

et al. 2020

British Journal of Surgery

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“…The panel recommended NSM for early breast cancer and ductal carcinoma in situ (DCIS), and, unanimously, in the risk reducing setting. This latter indication is now well-established in clinical practice [ 4 , 5 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Weber

Haug

Kurzeder

et al. 2018

Breast Cancer Res Treat

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PurposeIndications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.MethodsThe panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.ResultsConsensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.ConclusionsIn case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.

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“…However, they acknowledged that longer follow-up was needed. The 2015 study of manning et al [17] retrospectively assessed 728 NSMs in performed 413 patients between 2000 and 2013: 269 for breast cancer, 459 for risk reduction, and 177 (24.3%) in patients known to have a BRCA1/2 mutation, or a genetic variant of uncertain significance. No breast cancers were diagnosed over a median follow-up of 2.15 years (IQR 0.11-8.14).…”

Section: Nsm For Risk Reducingmentioning

confidence: 99%

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

et al. 2017

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Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. NSM is closely similar except that the nipple-areola complex (NAC) is also conserved. Meta-analyses indicate that outcomes for SSM and NSM do not differ from those for non-conservative mastectomies. Recurrence rates in the NAC after NSM are acceptably low (0-3.7%). Other studies indicate that NSM is associated with high patient satisfaction and good psychological adjustment. Indications are carcinoma or DCIS that require mastectomy (including after neoadjuvant chemotherapy). NSM is also suitable for women undergoing risk-reducing bilateral mastectomy. Tumor not less than 2cm from the NAC is recommended, but may be less important than no evidence of nipple involvement on mandatory intraoperative nipple margin assessment. A positive margin is an absolute contraindication for nipple preservation. Other contraindications are microcalcifications close to the subareolar region and a positive nipple discharge. Complication rates are similar to those for other types of post-mastectomy reconstructions. The main complication of NSM is NAC necrosis, however as surgeon experience matures, frequency declines. Factors associated with complications are voluminous breast, ptosis, smoking, obesity, and radiotherapy. Since the access incision is small, breast tissue may be left behind, so only experienced breast surgeons should do these operations; close collaboration with the plastic surgeon. For breast cancer patients requiring mastectomy, NSM should be the option of choice.

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Nipple-sparing mastectomy in patients withBRCA1/2mutations and variants of uncertain significance

Cited by 77 publications

References 20 publications

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

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

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

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