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.
authors.affiliation: Department of Pathology, Mayo Clinic, Division of Anatomic Pathology, Rochester, MN, USA. reynolds.carol@mayo.edu
authors.forename: Carol
authors.initials: C
authors.lastname: Reynolds
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Davidson
authors.forename: Noralane M
authors.initials: NM
authors.lastname: Lindor
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Glazebrook
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Sandhu
authors.forename: Molly F
authors.initials: MF
authors.lastname: Walsh
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Hartmann
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000235:genetics / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000235:genetics / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D011379:Prognosis
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human