Abstract P2-13-02: Nipple sparing mastectomy in patients with BRCA1 and BRCA2 mutations
Authors: Manning Aidan T , Pusic Andrea , Wood Caitlin , Eaton Anne , Stempel Michelle , Capko Deborah , Sacchini Virgilio 
Published: May 2015

Introduction: Nipple sparing mastectomy (NSM) is now performed with increasing frequency in both therapeutic and prophylactic breast surgery. The role of NSM in BRCA1 and BRCA2 mutation carriers has not been well described. The aim of this study was to review our experience with NSM in this high-risk population.

Methods: A review of the breast database was performed to identify all patients with documented BRCA mutations who underwent NSM at Memorial Sloan Kettering Cancer Center. Data extracted from the database included patient demographics, type of mutation, indication for surgery, type of reconstruction, and complications. For patients undergoing therapeutic mastectomy, data on disease stage, axillary procedures, and follow-up were also extracted.

Results: 177 NSMs (88 bilateral, 1 unilateral) were performed in 89 female patients with a documented BRCA mutation between September 2005 and December 2013. There were 56 patients with BRCA1 mutation, 26 with BRCA2 mutation, and 7 with genetic variants of uncertain significance. 26 patients had a therapeutic NSM for breast cancer (stage 0: n=6; stage 1: n=15; stage 2: n=5) and concurrent contralateral prophylactic mastectomy (CPM). The mean tumor size was 1.46cm (range, 0.1-3.5cm), and all were node negative following sentinel lymph node biopsy. 63 patients had NSM for prophylaxis. The mean age of patients undergoing therapeutic NSM was 41 years (range, 26-59) and prophylactic NSM was 39 years (25-59). There was an incidental diagnosis of ductal carcinoma in situ (DCIS) in 4 women undergoing CPM and 4 patients undergoing prophylactic NSM, including 1 patient diagnosed with bilateral DCIS, and an incidental diagnosis of atypia in 8 patients undergoing prophylactic NSM. In 26 patients undergoing therapeutic NSM, at median follow-up of 2.34 years (range, 0.45-6.06) there were no local or regional recurrences. One patient developed distant metastases and subsequently died from her disease, and 1 other patient died from metastatic ovarian cancer. In 63 patients undergoing prophylactic NSM, at median follow-up of 2.15 years (range, 0.11-8.14) there were no newly diagnosed breast cancers or deaths. Following NSM, 5 patients (5.6%) required subsequent excision of the nipple-areolar complex (3 cases for close or positive DCIS on final histology, 1 case for infection with necrosis, and 1 case for ongoing nipple discharge). All 89 patients had immediate breast reconstruction (tissue expander: n=80; permanent implant: n=8; autologous (DIEP) flap: n=1). Postoperative complications are shown in Table 1.

Postoperative complications following 177 nipple sparing mastectomies performed in 89 patients with BRCA mutations No. of Breasts; n (%)No. of Patients; n (%)Skin desquamation68 (38.4)40 (44.9)Necrosis requiring debridement18 (10.2)13 (14.6)Infection7 (4.0)7 (7.9)Hematoma3 (1.69)3 (3.4)Complication requiring implant or tissue expander removal6 (3.4)6 (6.7)

Conclusion: NSM is an acceptable choice for patients with BRCA gene mutations undergoing therapeutic or prophylactic mastectomy with no evidence of compromise to oncological safety. This report shows an acceptable complication rate, and patients rarely required subsequent excision of the nipple-areolar complex.

Citation Format: Aidan T Manning, Andrea Pusic, Caitlin Wood, Anne Eaton, Michelle Stempel, Deborah Capko, Virgilio Sacchini. Nipple sparing mastectomy in patients with BRCA1 and BRCA2 mutations [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-02.