Prophylactic and therapeutic mastectomy in BRCA mutation carriers: Can the nipple be preserved?

Carol Reynolds, Jennifer A. Davidson, Noralane Morey Lindor, Katrina Nesta Glazebrook, James W Jakub, Amy C Degnim, Nicole P. Sandhu, Molly F. Walsh, Lynn C. Hartmann, Judy C Boughey

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Abstract

Background: Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers. Methods: Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple-areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted. Results: Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct. Conclusions: The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10%) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24% of NACs contained TDLUs, with only 8% found in the nipple papilla; the significance of this for long-term risk is unknown.

Original languageEnglish (US)
Pages (from-to)3102-3109
Number of pages8
JournalAnnals of Surgical Oncology
Volume18
Issue number11
DOIs
StatePublished - Oct 2011

Fingerprint

Nipples
Mutation
Mastectomy
Therapeutics
Hyperplasia
Prophylactic Mastectomy
Carcinoma
Carcinoma, Intraductal, Noninfiltrating
Carcinoma in Situ

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Prophylactic and therapeutic mastectomy in BRCA mutation carriers : Can the nipple be preserved? / Reynolds, Carol; Davidson, Jennifer A.; Lindor, Noralane Morey; Glazebrook, Katrina Nesta; Jakub, James W; Degnim, Amy C; Sandhu, Nicole P.; Walsh, Molly F.; Hartmann, Lynn C.; Boughey, Judy C.

In: Annals of Surgical Oncology, Vol. 18, No. 11, 10.2011, p. 3102-3109.

Research output: Contribution to journalArticle

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title = "Prophylactic and therapeutic mastectomy in BRCA mutation carriers: Can the nipple be preserved?",
abstract = "Background: Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers. Methods: Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple-areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted. Results: Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24{\%}) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7{\%}) had malignant findings and 1 (3{\%}) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct. Conclusions: The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10{\%}) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24{\%} of NACs contained TDLUs, with only 8{\%} found in the nipple papilla; the significance of this for long-term risk is unknown.",
author = "Carol Reynolds and Davidson, {Jennifer A.} and Lindor, {Noralane Morey} and Glazebrook, {Katrina Nesta} and Jakub, {James W} and Degnim, {Amy C} and Sandhu, {Nicole P.} and Walsh, {Molly F.} and Hartmann, {Lynn C.} and Boughey, {Judy C}",
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T1 - Prophylactic and therapeutic mastectomy in BRCA mutation carriers

T2 - Can the nipple be preserved?

AU - Reynolds, Carol

AU - Davidson, Jennifer A.

AU - Lindor, Noralane Morey

AU - Glazebrook, Katrina Nesta

AU - Jakub, James W

AU - Degnim, Amy C

AU - Sandhu, Nicole P.

AU - Walsh, Molly F.

AU - Hartmann, Lynn C.

AU - Boughey, Judy C

PY - 2011/10

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N2 - Background: Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers. Methods: Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple-areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted. Results: Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct. Conclusions: The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10%) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24% of NACs contained TDLUs, with only 8% found in the nipple papilla; the significance of this for long-term risk is unknown.

AB - Background: Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers. Methods: Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple-areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted. Results: Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct. Conclusions: The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10%) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24% of NACs contained TDLUs, with only 8% found in the nipple papilla; the significance of this for long-term risk is unknown.

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