Abstract
BackgroundBilateral nipple‐sparing mastectomy (NSM) is a technically feasible operation and is associated with excellent cosmetic outcomes. The aim of this study was to evaluate trends in patient characteristics, indications for surgery and long‐term outcomes of bilateral NSM for breast cancer risk reduction over time.MethodsA review of a single‐centre experience with bilateral NSM performed between 2001 and 2017 for breast cancer risk reduction in patients without breast cancer was performed. Trends in patient characteristics and indications for surgery were evaluated over four time intervals: 2001–2005, 2006–2009, 2010–2013 and 2014–2017. Statistical analysis was performed using χ2 tests.ResultsOver the study period, 272 NSMs were performed in 136 patients; their median age was 41 years. The number of bilateral NSMs performed increased over time. The most common indication was a mutation in breast cancer‐associated genes (104 patients, 76·5 per cent), which included BRCA1 (62 patients), BRCA2 (35), PTEN (2), TP53 (3) and ATM (2). Other indications were family history of breast cancer (19 patients, 14·0 per cent), lobular carcinoma in situ (10, 7·4 per cent) and a history of mantle irradiation (3, 2·2 per cent). The proportion of patients having a bilateral NSM for mutation in a breast cancer‐associated gene increased over time (2001–2005: 2 of 12; 2006–2009: 9 of 17; 2010–2013: 34 of 41; 2014–2017: 61 of 66; P < 0·001). Mean follow‐up was 53 months; no breast cancers were found during follow‐up.ConclusionThe use of bilateral NSM for breast cancer risk reduction is increasing and the indications have evolved over the past 16 years. These excellent long‐term oncological results suggest that bilateral NSM is a good option for surgical breast cancer risk reduction.
Highlights
Risk-reducing simple mastectomy, subcutaneous mastectomy and skin-sparing mastectomy have all been demonstrated to be associated with breast cancer risk reduction in patients with a strong family history of breast cancer and in patients with mutations in BRCA1 and BRCA2 genes[1,2,3]
A risk-reducing bilateral nipple-sparing mastectomy (NSM) for patients with genetic mutations was first performed for BRCA, PTEN, TP53 and ATM in 2004, 2013, 2013 and 2015 respectively
NSM has the advantage of preserving the nipple and skin envelope to optimize cosmesis following mastectomy, and it facilitates the reconstruction process[7,21]
Summary
Risk-reducing simple mastectomy, subcutaneous mastectomy and skin-sparing mastectomy have all been demonstrated to be associated with breast cancer risk reduction in patients with a strong family history of breast cancer and in patients with mutations in BRCA1 and BRCA2 genes[1,2,3]. Over the past 15 years, nipple-sparing mastectomy (NSM) has emerged as an option for the treatment and prevention of breast cancer in selected patients[4,5] These reports and others[6,7,8,9,10,11,12,13,14] have established the technical feasibility of NSM. The aim of this study was to evaluate trends in patient characteristics, indications for surgery and long-term outcomes of bilateral NSM for breast cancer risk reduction over time. Conclusion: The use of bilateral NSM for breast cancer risk reduction is increasing and the indications have evolved over the past 16 years These excellent long-term oncological results suggest that bilateral NSM is a good option for surgical breast cancer risk reduction
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