Nav: Home

Protective mastectomies that preserve nipple safe for women at high breast cancer risk

April 14, 2016

DALLAS -- Protective mastectomies that preserve the nipple and surrounding skin prevent breast cancer as effectively as more invasive surgeries for women with a genetic mutation called BRCA that raises their risk of developing breast cancer, a multi-institution study led by Mayo Clinic found. The research should reassure patients and surgeons that nipple-sparing mastectomies, which leave women with more natural-looking breasts than other mastectomies, are a safe way to reduce breast cancer risk in BRCA carriers, the authors say. The findings were presented at the annual meeting of the American Society of Breast Surgeons in Dallas.

MULTIMEDIA ALERT: Video and audio are available for download on the Mayo Clinic News Network.

"Nipple-sparing mastectomy is gaining wide acceptance because of its superior cosmetic results, but pockets of the medical community remain skeptical that it is the right choice for the BRCA population," says study lead author James Jakub, M.D., a breast surgeon at Mayo Clinic in Rochester, Minnesota. "This is the largest study of its kind to address the controversy, and to show that nipple-sparing mastectomy is as effective at preventing breast cancer as traditional mastectomy."

To determine the incidence of breast cancer in BCRA-positive women who had prophylactic nipple-sparing mastectomies, researchers studied outcomes among 348 patients who collectively had 551 mastectomies performed at nine institutions between 1968 and 2013.

The study included 203 women who had both breasts removed protectively, known as a bilateral mastectomy, and 145 patients who had one breast removed preventively after cancer occurred in the other breast.

None of the patients who had a bilateral nipple-sparing mastectomy developed breast cancer at any site after an average of three to five years of follow-up, the researchers found. No breast cancers developed in the retained skin, nipples, or lymph nodes on the side of the prophylactic procedure. Seven women died from breast cancer during follow-up; in all of those cases the patients had a previous or concurrent breast cancer at the time of surgery and their stage IV disease was attributed to that cancer.

Mastectomies have changed dramatically over the years. The radical mastectomy of the 1950s, 60s, and 70s removed the breast tissue, skin, lymph nodes, and underlying muscle. By the 1980s, that procedure largely gave way to the modified radical mastectomy, which left the chest muscles alone. Next came skin-sparing mastectomies, which preserve an envelope of skin and allow surgeons to begin breast reconstruction during the mastectomy surgery.

Nipple-sparing mastectomies leave the nipple, areola and breast skin intact. Their use is increasing and has gained acceptance as a safe option in breast cancer patients.

In 2009, approximately 8 percent of mastectomies performed at Mayo Clinic were nipple-sparing. Five years later, that fraction had more than tripled to approximately 30 percent, and Dr. Jakub says the number is increasing. Still, controversy remains over whether or not the procedure is appropriate for women with BRCA mutations, who can have a breast cancer risk of 50 to 60 percent by age 70 and up to 80 percent over a lifetime.

"The BRCA population has a genetic mutation in all the cells of their body that predisposes them to breast cancer," Dr. Jakub says. "We know that a majority of breast cancers originate in the breast ducts, so it might seem counterintuitive to leave behind the nipple and the ducts associated with the nipple when you are trying to reduce the risk of this disease."

Several studies have shown the procedure is safe among BCRA carriers, but some physicians have been waiting for more evidence, Dr. Jakub says. He believes the study results offer further proof that nipple-sparing mastectomies are effective in preventing breast cancer among women carrying the BRCA mutation and should be offered when they consider prophylactic surgery.

"There is no question that this option of nipple-sparing mastectomy can often provide an outstanding cosmetic result and may make it easier for women who are at risk to take this preventive measure," Dr. Jakub says. "Though the nipple is preserved, it unfortunately will not have stimulation or arousal. Despite that, studies looking at the impact of risk-reducing surgery on quality of life, sexual satisfaction, and intimacy, suggest that being able to preserve aesthetics and body image can improve all of these factors."
-end-
The study's senior author is Shawna Willey, M.D., of Georgetown University. The co-authors are Richard Gray, M.D., and Sarah McLaughlin, M.D., of Mayo Clinic; Anne Peled, M.D., of the University of California San Francisco; Rachel Greenup, M.D., of Duke University; John Kiluk, M.D., of Moffitt Cancer Center; Virgilio Sacchini, M.D., of Memorial Sloan Kettering; and Julia Tchou, M.D., Ph.D., of the University of Pennsylvania.

The study was supported by National Institutes of Health Specialized Program of Research Excellence in Breast Cancer grant CA116201 and the Breast Cancer Research Foundation.

About Mayo Clinic Cancer Center

As a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call 1-855-776-0015 (toll-free).

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or http://newsnetwork.mayoclinic.org/.

Mayo Clinic

Related Breast Cancer Articles:

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.
Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.
Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.
More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.
Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.
Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.
Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.
Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.
Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.
Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
More Breast Cancer News and Breast Cancer Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab