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Medline ® Abstract for Reference 19

of 'Management of patients at high risk for breast and ovarian cancer'

19
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Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature.
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Yao K, Liederbach E, Tang R, Lei L, Czechura T, Sisco M, Howard M, Hulick PJ, Weissman S, Winchester DJ, Coopey SB, Smith BL
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Ann Surg Oncol. 2015 Feb;22(2):370-6. Epub 2014 Jul 15.
 
BACKGROUND: There are few large-scale studies that have examined outcomes for BRCA1/2 carriers who have undergone nipple-sparing mastectomy (NSM). The objective of our study was to examine incidental cancers, operative complications, and locoregional recurrences in BRCA1/2 mutation carriers who underwent NSM for both risk reduction and cancer treatment.
METHODS: This was a retrospective review of pathology results and outcomes of 201 BRCA1/2 carriers from two different institutions who underwent NSM from 2007 to 2014.
RESULTS: NSM was performed in 397 breasts of 201 BRCA1/2 carriers. One hundred and twenty-five (62.2 %) patients had a BRCA1 mutation and 76 (37.8 %) had a BRCA2 mutation; 150 (74.6 %) patients underwent NSM for risk reduction and 51 (25.4 %) for cancer. Incidental cancers were found in four (2.7 %) of the 150 risk-reduction patients and two (3.9 %) of the 51 cancer patients. The nipple-areolar complex (NAC) was involved with cancer in three (5.8 %) patients. No prophylactic mastectomy had a positive NAC margin. There was loss of the NAC in seven breasts (1.8 %) and flap necrosis in ten (2.5 %) breasts. With a mean follow-up of 32.6 months (1-76 months), there have been four cancer events-three in cancer patients and one in a risk-reduction patient but none at the NAC.
CONCLUSION: NSM in BRCA1/2 carriers is associated with a low rate of complications and locoregional recurrence but these patients require long-term follow-up in both the cancer and risk-reduction setting.
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Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA, kyao@northshore.org.
PMID