Total skin-sparing mastectomy in BRCA mutation carriers

Area of Science:

• Oncology
• Surgical Oncology
• Genetics

Background:

• Total skin-sparing mastectomy (TSSM) with nipple-areolar complex preservation is increasingly accepted.
• Oncologic safety in BRCA mutation carriers undergoing TSSM requires further study.

Purpose of the Study:

• To evaluate oncologic outcomes of TSSM in BRCA-positive patients.
• To compare outcomes between BRCA-positive and non-BRCA-positive patients undergoing TSSM.

Main Methods:

• Retrospective analysis of 53 BRCA-positive patients undergoing bilateral TSSM (2001-2011).
• Age- and stage-matched controls (non-BRCA-positive patients) were included.
• Outcomes assessed: nipple tissue tumor involvement, new breast cancers, and local-regional recurrence.

Main Results:

• No significant difference in nipple specimen tumor involvement between BRCA-positive and non-BRCA-positive patients for prophylactic (1.9% vs 3.8%) or therapeutic (0% vs 3.7%) indications.
• No new breast cancers developed in either cohort at mean follow-up of 51 months for prophylactic cases.
• No local-regional recurrences in BRCA-positive patients versus one in controls at mean follow-up of 37 months for therapeutic cases.

Conclusions:

• TSSM is an oncologically safe procedure for BRCA-positive patients.
• Risk-reducing TSSM in BRCA carriers shows no increased risk of new breast cancers at 4-year follow-up.
• Ongoing longer-term follow-up is necessary.