Total skin-sparing mastectomy in BRCA mutation carriers

Anne Warren Peled, Chetan Irwin, E. Shelley Hwang, Cheryl A. Ewing, Michael Alvarado, Laura J. Esserman

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex skin has become increasingly accepted as an oncologically safe procedure. Oncologic outcomes after TSSM in BRCA mutation carriers have not been well-studied. Methods: We identified 53 BRCA-positive patients who underwent bilateral TSSM for prophylactic (26 patients) or therapeutic indications (27 patients) from 2001 to 2011. Cases were age-matched (for prophylactic cases) or age- and stage-matched (for therapeutic cases) with non-BRCA-positive patients. Outcomes included tumor involvement of resected nipple tissue, the development of new breast cancers in patients who underwent risk-reducing TSSM, and local-regional recurrence in patients who underwent therapeutic TSSM. Results: Outcomes from 212 TSSM procedures in 53 cases and 53 controls were analyzed. In patients undergoing TSSM for prophylactic indications, in situ cancer was found in one (1.9 %) nipple specimen in BRCA-positive patients versus two specimens (3.8 %) in the non-BRCA-positive cohort (p = 1). At a mean follow-up of 51 months, no new cancers developed in either cohort. In patients undergoing TSSM for therapeutic indications, in situ or invasive cancer was found in zero of the nipple specimens in BRCA-positive patients versus two specimens (3.7 %) in the non-BRCA-positive cohort (p = 0.49). At a mean follow-up of 37 months, there were no local-regional recurrences in the BRCA-positive cohort and 1 (3.7 %) in the non-BRCA-positive cohort. Conclusions: TSSM is an oncologically safe procedure in BRCA-positive patients. In patients undergoing TSSM as a risk-reducing strategy, 4-year follow-up demonstrates no increased risk of developing new breast cancers; longer-term follow-up is ongoing.

Original languageEnglish (US)
Pages (from-to)37-41
Number of pages5
JournalAnnals of Surgical Oncology
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Mastectomy
Skin
Mutation
Nipples
Neoplasms
Breast Neoplasms
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Peled, A. W., Irwin, C., Hwang, E. S., Ewing, C. A., Alvarado, M., & Esserman, L. J. (2014). Total skin-sparing mastectomy in BRCA mutation carriers. Annals of Surgical Oncology, 21(1), 37-41. https://doi.org/10.1245/s10434-013-3230-0

Total skin-sparing mastectomy in BRCA mutation carriers. / Peled, Anne Warren; Irwin, Chetan; Hwang, E. Shelley; Ewing, Cheryl A.; Alvarado, Michael; Esserman, Laura J.

In: Annals of Surgical Oncology, Vol. 21, No. 1, 01.01.2014, p. 37-41.

Research output: Contribution to journalArticle

Peled, AW, Irwin, C, Hwang, ES, Ewing, CA, Alvarado, M & Esserman, LJ 2014, 'Total skin-sparing mastectomy in BRCA mutation carriers', Annals of Surgical Oncology, vol. 21, no. 1, pp. 37-41. https://doi.org/10.1245/s10434-013-3230-0
Peled, Anne Warren ; Irwin, Chetan ; Hwang, E. Shelley ; Ewing, Cheryl A. ; Alvarado, Michael ; Esserman, Laura J. / Total skin-sparing mastectomy in BRCA mutation carriers. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 1. pp. 37-41.
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abstract = "Background: Total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex skin has become increasingly accepted as an oncologically safe procedure. Oncologic outcomes after TSSM in BRCA mutation carriers have not been well-studied. Methods: We identified 53 BRCA-positive patients who underwent bilateral TSSM for prophylactic (26 patients) or therapeutic indications (27 patients) from 2001 to 2011. Cases were age-matched (for prophylactic cases) or age- and stage-matched (for therapeutic cases) with non-BRCA-positive patients. Outcomes included tumor involvement of resected nipple tissue, the development of new breast cancers in patients who underwent risk-reducing TSSM, and local-regional recurrence in patients who underwent therapeutic TSSM. Results: Outcomes from 212 TSSM procedures in 53 cases and 53 controls were analyzed. In patients undergoing TSSM for prophylactic indications, in situ cancer was found in one (1.9 {\%}) nipple specimen in BRCA-positive patients versus two specimens (3.8 {\%}) in the non-BRCA-positive cohort (p = 1). At a mean follow-up of 51 months, no new cancers developed in either cohort. In patients undergoing TSSM for therapeutic indications, in situ or invasive cancer was found in zero of the nipple specimens in BRCA-positive patients versus two specimens (3.7 {\%}) in the non-BRCA-positive cohort (p = 0.49). At a mean follow-up of 37 months, there were no local-regional recurrences in the BRCA-positive cohort and 1 (3.7 {\%}) in the non-BRCA-positive cohort. Conclusions: TSSM is an oncologically safe procedure in BRCA-positive patients. In patients undergoing TSSM as a risk-reducing strategy, 4-year follow-up demonstrates no increased risk of developing new breast cancers; longer-term follow-up is ongoing.",
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AU - Peled, Anne Warren

AU - Irwin, Chetan

AU - Hwang, E. Shelley

AU - Ewing, Cheryl A.

AU - Alvarado, Michael

AU - Esserman, Laura J.

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AB - Background: Total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex skin has become increasingly accepted as an oncologically safe procedure. Oncologic outcomes after TSSM in BRCA mutation carriers have not been well-studied. Methods: We identified 53 BRCA-positive patients who underwent bilateral TSSM for prophylactic (26 patients) or therapeutic indications (27 patients) from 2001 to 2011. Cases were age-matched (for prophylactic cases) or age- and stage-matched (for therapeutic cases) with non-BRCA-positive patients. Outcomes included tumor involvement of resected nipple tissue, the development of new breast cancers in patients who underwent risk-reducing TSSM, and local-regional recurrence in patients who underwent therapeutic TSSM. Results: Outcomes from 212 TSSM procedures in 53 cases and 53 controls were analyzed. In patients undergoing TSSM for prophylactic indications, in situ cancer was found in one (1.9 %) nipple specimen in BRCA-positive patients versus two specimens (3.8 %) in the non-BRCA-positive cohort (p = 1). At a mean follow-up of 51 months, no new cancers developed in either cohort. In patients undergoing TSSM for therapeutic indications, in situ or invasive cancer was found in zero of the nipple specimens in BRCA-positive patients versus two specimens (3.7 %) in the non-BRCA-positive cohort (p = 0.49). At a mean follow-up of 37 months, there were no local-regional recurrences in the BRCA-positive cohort and 1 (3.7 %) in the non-BRCA-positive cohort. Conclusions: TSSM is an oncologically safe procedure in BRCA-positive patients. In patients undergoing TSSM as a risk-reducing strategy, 4-year follow-up demonstrates no increased risk of developing new breast cancers; longer-term follow-up is ongoing.

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