Nipple-Sparing Mastectomy in Patients with Germline BRCA Mutations: Is it Safe?

Abstract

Through most of recorded medical history, there has been debate about how much healthy tissue should be removed in order to effectively treat breast cancer. The prevailing opinion at the start of the twentieth century was “a lot.” The trend has been reversed in recent decades as advances in systemic treatments and radiation therapy have pushed local recurrence rates down even as breast surgery has become markedly less destructive. There is still debate, however, over the nipple-areolar complex in patients requiring mastectomy. A wealth of data has now accumulated demonstrating that occult nipple involvement with cancer is rare, and usually identifiable in appropriately obtained tissue samples; that leaving the nipple behind does not need to leave a lot of breast tissue behind; that the nipple is not a favored site of recurrence; and that local recurrence rates are quite low in selected breast cancer patients treated with nipple-sparing mastectomy. There has been concern, however, that BRCA gene mutation carriers may be at greater than average risk for new primary breast cancers if the nipple is preserved. Available case series are small and follow-up is short, but thus far, there is no signal to suggest that this is the case. Thorough, oncologically sound nipple-sparing mastectomy appears safe in BRCA gene mutation carriers.