Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients

Breast Cancer Res Treat. 2020 May;181(1):69-75. doi: 10.1007/s10549-020-05582-w. Epub 2020 Mar 25.

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.

Keywords: Breast neoplasm; Genetic predisposition to disease; Prophylactic surgical procedures; Subcutaneous mastectomy.

MeSH terms

  • Adult
  • Brazil
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / surgery*
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Mastectomy / methods
  • Mastectomy / statistics & numerical data
  • Middle Aged
  • Nipples / pathology
  • Nipples / surgery
  • Organ Sparing Treatments / adverse effects
  • Organ Sparing Treatments / methods
  • Prognosis
  • Prophylactic Mastectomy / adverse effects
  • Prophylactic Mastectomy / methods
  • Retrospective Studies
  • Risk