Abstract
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.
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Data availability
All data analyzed during this study are included in this published article.
References
Narod SA (2010) BRCA mutations in the management of breast cancer: the state of the art. Nat Rev Clin Oncol 7(12):702–707. https://doi.org/10.1038/nrclinonc.2010.166
Castera L, Krieger S, Rousselin A et al (2014) Next-generation sequencing for the diagnosis of hereditary breast and ovarian cancer using genomic capture targeting multiple candidate genes. Eur J Hum Genet 22:1305–1313. https://doi.org/10.1038/ejhg.2014.16
Kuchenbaecker KB, Hopper JL, Barnes DR et al (2017) Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 317(23):2402–2416. https://doi.org/10.1001/jama.2017.7112
Dull B, Conant L, Myckatyn T et al (2017) Nipple-sparing mastectomies: Clinical outcomes from a single academic institution. Mol Clin Oncol 6:737–742. https://doi.org/10.3892/mco.2017.1208
Smith BL, Tang R, Rai U et al (2017) Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg 225(3):361–365. https://doi.org/10.1016/j.jamcollsurg.2017.06.013
Liede A, Cai M, Crouter TF et al (2018) Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 171(2):435–442. https://doi.org/10.1007/s10549-018-4824-9
Isaksson K, Arver B, Bottai M et al (2019) Bilateral risk-reducing mastectomies with implant-based reconstructions followed long term: a consecutive series of 185 patients. World J Surg 43:2262–2270. https://doi.org/10.1007/s00268-019-05037-4
Manning AT, Wood C, Eaton A et al (2015) Nipple-sparing mastectomy in patients with BRCA1/2 mutations and variants of uncertain significance. Br J Surg 102(11):1354–1359. https://doi.org/10.1002/bjs.9884
Tondu T, Thiessen F, Tjalma WA (2016) Prophylatic bilateral Nipple-sparing mastectomy ans a staged breast reconstruction technique: preliminar results. Breast Cancer 10:185–189. https://doi.org/10.4137/BCBCR.S40033
Muller T, Baratte A, Bruant-Rodier C et al (2018) Oncological safety of nipple-sparing prophylactic mastectomy: a review of the literature on 3716 cases. Ann Chir Plast Esthet 63(3):e6–e13. https://doi.org/10.1016/j.anplas.2017.09.005
Jakub JW, Peled AW, Gray RJ et al (2018) Oncologic safety of prophylactic nipple-sparing mastectomy in a population with BRCA mutations: a multi-institutional study. JAMA 153(2):123–129. https://doi.org/10.1001/jamasurg.2017.3422
Muller T, Baratte A, Bruant-Roider C et al (2018) Oncological safety of nipple-sparing prophylactic mastectomy: a review of the literature on 3716 cases. Ann Chir Plast Esthet 63(3):e6–e13. https://doi.org/10.1016/j.anplas.2017.09.005
Grobmyer SR, Pederson HJ, Valente SA (2018) Evolving indications and long-term oncological outcomes of risk-reducing bilateral nipple-sparing mastectomy. BJS Open 3(2):169–173. https://doi.org/10.1002/bjs5.50117
Wu ZY, Kim HJ, Lee JW et al (2019) Breast cancer recurrence in the nipple-areola complex after nipple-sparing mastectomy with immediate breast reconstruction for invasive breast cancer. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.2959
Eisemann BS, Spiegel AJ (2018) Mastectomy and breast reconstruction: indications and evidence for current management strategies. Clin Plast Surg 45:129–136. https://doi.org/10.1016/j.cps.2017.08.013
Henry DA, Lee MC, Almanza D et al (2019) Trends in use of bilateral prophylactic mastectomy vs high-risk surveillance in unaffected carriers of inherited breast cancer syndromes in the Inherited Cancer Registry (ICARE). Breast Cancer Res Treat 174(1):39–45. https://doi.org/10.1007/s10549-018-5057
Beitsch PD, Whitworth PW, Hughes K et al (2019) Underdiagnosis of hereditary breast cancer: are genetic testing guidelines a tool or an obstacle? J Clin Oncol 37(6):453–460. https://doi.org/10.1200/JCO.18.01631
Graffeo R, Livraghi L, Pagani O et al (2016) Time too incorporate germline multigene panel testing into breast and ovarian cancer patient care. Breast Cancer Res Treat 160(3):393–410. https://doi.org/10.1007/s10549-016-4003-9
Henry DA, Lee MC, Almanza D et al (2019) Trends in use of bilateral prophylactic mastectomy vs high-risk surveillance in unaffected carriers of inherited breast cancer syndroms in the Inherited Cancer Registry (ICARE). Breast Cancer Res Treat 174(1):39–45. https://doi.org/10.1007/s10549-018-5057-7
Mau C, Untch M (2017) Prophylactic surgey: for whom, when and how? Breast Care 12(6):379–384. https://doi.org/10.1159/000485830
Nelson HD, Pappas M, Cantor A et al (2019) Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: Update evidence reports and systemic review for the US preventive services task force. JAMA. 332(7):666–685. https://doi.org/10.1001/jama.2019.8430
Hermel DJ, Wood ME, Chun J et al (2017) Multi-institutional evaluation of women at high risk of developing breast cancer. Clin Breast Cancer 17(6):427–432. https://doi.org/10.1016/j.clbc.2017.04.005
Gilbert E, Zabor EC, Stempel M et al (2017) Differences among a modern cohort of BRCA mutation carriers choosing bilateral prophylactic mastectomies compared to breast surveillance. Am Surg Oncol 24:3048–3054. https://doi.org/10.1245/s10434-017-5976-2
De Felice F, Marchetti C, Musella A et al (2015) Bilateral risk-reduction mastectomy in BRCA1 and BRCA2 mutation carriers: a meta-analysis. Ann Surg Oncol 22:2876–2880. https://doi.org/10.1245/s10434-015-4532-1
Yao K, Liederbach E, Tang R et al (2015) Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol 22:370–376. https://doi.org/10.1245/s10434-014-3883-3
Lai HW, Chen ST, Tai CM et al (2020) Robotic- versus Endoscopic-assisted nipple-sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer: a case-control comparison study with analysis of clinical outcomes, learning curve, patient-reported aesthetic results, and medical cost. Ann Surg Oncol. https://doi.org/10.1245/s10434-020-08223-0
Lai HW, Toesca A, Sarfari B et al (2020) Consensus statement on robotic mastectomy-expert panel from international endoscopic and robotic breast surgery symposium (IERBS) 2019. Ann Surg. https://doi.org/10.1097/SLA.0000000000003789
Sarfari B, Leymarie N, Honart JF et al (2018) Robotic prophylactic nipple-sparing mastectomy with immediate prosthetic breast reconstruction: a prospective study. Ann Surg Oncol 25(9):2579–2586. https://doi.org/10.1245/s10434-018-6555-x
Houvenaeghel G, Marie B, Rua S et al (2019) Robotic breast and reconstructive surgery: 100 procedures in 2-years for 80 patients. Surg Oncol 31:38–45. https://doi.org/10.1016/j.suronc.2019.09.005
Maruccia M, Elia R, Gurrado A et al (2020) Skin-reducing mastectomy and pre-pectoral breast reconstruction in large ptotic breasts. Aesth Plast Surg. https://doi.org/10.1007/s00266-020-01616-2
Vidya R, Iqbal FM, Becker H, Zhadan O (2019) World J Plast Surg 8(3):311–315. https://doi.org/10.29252/wjps.8.3.311
Khajuria A, Prokopenko M, Greenfield M et al (2019) A meta-analysis of clinical, patient-reported outcomes and cost of DIEP versus implant-based breast reconstruction. Plast Reconstr Surg Glob Open 7(10):e2486
Wade RG, Razzano S, Sassoon EM et al (2017) Complications in DIEP flap breast reconstruction after mastectomy for breast cancer: a prospective cohort study comparing unilateral versus bilateral reconstructions. Ann Surg Oncol 24(6):1465–1474. https://doi.org/10.1245/s10434-017-5807-5
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The authors disclosure that they have no commercial interest in the subject of study and received no financial or material support for the study.
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All authors contributed to the study conception and design. Material preparation and writing the manuscript were performed by ALF, MAMRF, ABF, BV and FB; data collection, analysis and writing the manuscript were perfomed by ML and ABAS. The first draft of the manuscript was written by MLs and all authors commented on previous versions of the manuscript. Supervision was performed by ALF.
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All procedures performed in the study were in accordance with the ethical standards by the Institutional Ethics Committee of Pontifical Catholic University of Rio Grande do Sul (PUCRS), Hospital Albert Einstein and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Frasson, A.L., Lichtenfels, M., de Souza, A.A.B. et al. Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients. Breast Cancer Res Treat 181, 69–75 (2020). https://doi.org/10.1007/s10549-020-05582-w
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DOI: https://doi.org/10.1007/s10549-020-05582-w