title: Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA, kyao@northshore.org.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
authors.forename: Erik
authors.initials: E
authors.lastname: Liederbach
authors.forename: Rong
authors.initials: R
authors.lastname: Tang
authors.forename: Lan
authors.initials: L
authors.lastname: Lei
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czechura
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
authors.forename: Michael
authors.initials: M
authors.lastname: Howard
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hulick
authors.forename: Scott
authors.initials: S
authors.lastname: Weissman
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Coopey
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D009558:Nipples; D012189:Retrospective Studies