Department of Plastic Surgery, Bulovka Hospital, Prague, Czech Republic.
First Faculty of Medicine, Charles University, Prague, Czech Republic.
Aesthetic Plast Surg. 2022 Apr;46(2):706-711. doi: 10.1007/s00266-021-02506-x. Epub 2021 Aug 3.
Mutations in the BRCA1 or BRCA2 genes increase the lifetime risk of developing breast cancer to 68-72% by the age of 80. One of the modalities to manage the risk is a prophylactic mastectomy. Bilateral nipple-sparing mastectomy specifically offers the most favorable esthetic outcomes but the evidence for its oncological safety remains limited. Thus, we aimed to compare the occurrence of breast cancer between nipple-sparing mastectomy and surveillance groups of BRCA1 or BRCA 2 mutations carriers.
BRCA1 or BRCA2-positive patients undergoing bilateral prophylactic nipple-sparing mastectomy at our department were identified. Only those unaffected by breast cancer were eligible. Each patient was pair-matched with a BRCA1 or BRCA2-positive patient of equal age from the surveillance group. Breast cancer incidence in both groups was recorded and the results were compared.
None of 105 patients who underwent NSM between 2009 and 2019 at a single institution with a mean follow-up time of 50 months developed breast cancer over this time period. One patient in this group died of an unrelated cause. Nine patients from 105 in the match-paired surveillance group were diagnosed with breast cancer during a mean follow-up time of 58.3 months, however, none of them died.
To the best of our knowledge, this is the largest single-center study of risk-reducing bilateral NSM in healthy BRCA1 or BRCA2 mutation carriers. Based on our results and those of other series, we conclude that NSM in its current form appears to be at least equally as safe as other types of mastectomy for preventing breast cancer in BRCA1 or BRCA2 mutation carriers.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
BRCA1 或 BRCA2 基因突变使个体在 80 岁前患乳腺癌的终生风险增加至 68%-72%。降低风险的方法之一是预防性乳房切除术。保留乳头的双侧乳房切除术特别能提供最有利的美容效果，但关于其肿瘤安全性的证据仍然有限。因此，我们旨在比较 BRCA1 或 BRCA2 基因突变携带者中保留乳头的乳房切除术与监测组的乳腺癌发生情况。
在我们科室，确定了接受双侧预防性保留乳头的乳房切除术的 BRCA1 或 BRCA2 阳性患者。只有未患乳腺癌的患者有资格参加。每位患者均与监测组中年龄相等的 BRCA1 或 BRCA2 阳性患者进行配对。记录两组的乳腺癌发病率，并比较结果。
在单中心机构中，105 名患者在 2009 年至 2019 年期间接受 NSM，中位随访时间为 50 个月，在此期间均未发生乳腺癌。这组中有 1 例患者因非相关原因死亡。在中位随访时间为 58.3 个月的配对监测组中，有 9 名患者被诊断为乳腺癌，但他们均未死亡。
据我们所知，这是健康的 BRCA1 或 BRCA2 基因突变携带者中，最大的单侧中心风险降低的双侧 NSM 研究。基于我们的结果和其他系列的结果，我们得出结论，保留乳头的双侧乳房切除术在预防 BRCA1 或 BRCA2 基因突变携带者乳腺癌方面，其目前的形式似乎与其他类型的乳房切除术同样安全。
证据等级 IV：本刊要求作者为每篇文章分配一个证据等级。如需全面了解这些循证医学评级，请参考目录或在线作者指南（www.springer.com/00266）。
