If you’ve inherited a high risk for breast cancer and you’re considering preventive mastectomy, you’ll be interested in the results of new research about nipple-sparing mastectomy (NSM) among women with a BRCA1 or BRCA2 mutation.
Once considered to be risky and unwise, NSM has been vindicated as a safe procedure for most women. Lot of data in the past few years bears this out. In fact, as research further reinforces that NSM is indeed a viable option for women facing mastectomy, the medical community is finding that eligibility for NSM extends to more women than first thought.
First and foremost, nipple-preserving mastectomy has been found to be just as effective as less conservative procedures that remove the nipple. Some physicians, however, resolutely insist that NSM is folly for women who have preventive mastectomy as a way to reduce their extraordinarily high hereditary risk of developing breast cancer—they argue that because most breasts cancers develop in the breast ducts, it doesn’t make sense to remove the breast but leave behind the nipple and its associated ducts. Increasingly, however, evidence suggests that ductal tissue where most breast cancers develop is located deeper in the breast, while the nipple is primarily composed of skin cells.
Physicians at the Mayo Clinic conducted the largest study to-date to gauge the safety and effectiveness of NSM for the BRCA community. They studied the outcomes of mastectomies performed at 9 institutions, including:
- 348 women who collectively had 551 mastectomies.
- 204 women had a BRCA1 mutation; 144 had a BRCA2 mutation.
- 203 women had preventive bilateral mastectomy; 145 had contralateral mastectomy (one breast removed prophylactically after cancer occurred in the other breast).
Breast surgeon and lead study author James Jakub, MD wrote that, "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." At many institutions, the rate of NSM continues to rise. The Mayo Clinic reports that NSMs performed there rose from 8% in 2009 to approximately 30% in 2014, and continues to increase.
Although this study is small, and research regarding NSM will continue, it does point to the safety and effectiveness of NSM, which, when combined with immediate breast reconstruction, produces superior cosmetic results. (Retained nipples on the reconstructed breast typically flatten and don't retain much of their previous responsiveness). Even so, like many women, you may prefer the option of keeping a small but important aspect of your natural breasts.
Jakub J, et al. “Multi-institutional study of the oncologic safety of prophylactic nipple-sparing mastectomy in a BRCA population.” Oral presentation at the American Society of Breast Surgeons 17th Annual Meeting; April 13-18, 2016.