Oncological safety of prophylactic breast surgery: skin-sparing and nipple-sparing versus total mastectomy

Abstract

Women with a BRCA1/2 gene mutation and others with a high breast cancer risk may opt for bilateral prophylactic mastectomy. To allow for immediate breast reconstruction the skin envelope is left in situ with or without the nipple-areola complex (NAC). Although possibly leading to a more natural aesthetic outcome than the conventional total mastectomy, so-called skin-sparing mastectomies (SSM) and nipple-sparing mastectomies (NSM) may leave some breast glandular tissue in situ. The oncological risk associated with remaining breast glandular tissue is unclear. We present a case of primary breast cancer after prophylactic mastectomy followed by a review of the literature on remaining breast glandular tissue after various mastectomy techniques and oncological safety of prophylactic mastectomies.

Keywords: Risk-reduction; breast glandular tissue; nipple-sparing mastectomy (NSM); primary breast cancer; skin-sparing mastectomy (SSM); terminal duct lobular units; total mastectomy.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

A 43-year-old woman presented with a primary, ulcerous breast cancer in the right prophylactic mastectomy scar. Eight years before presentation she had undergone prophylactic mastectomy and immediate breast implant reconstruction because of a history of Mantle field radiation at the age of 15. Histology of the mastectomy specimens showed no (in situ) malignancy. (A) Computer-assisted Tomography (CT) scan of the thorax shows the tumor of 2.1×2.7 cm2 that invades the skin and causes dimpling of the subpectoral implant; (B) microscopic examination showed a grade 3 invasive ductal carcinoma with skin involvement, indicated by the arrowhead. Haematoxylin and eosin stained (H&E); 4× objective.