Ko Un Park1, Anna Weiss2, Kelly Rosso3, Min Yi4, Kelly Hunt4, Henry Kuerer4, Summer E Hanson5, Rosalind Candelaria6, Sarah Tevis7, Alastair Thompson8. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. koun.park@osumc.edu. 2. Department of Surgical Oncology, Brigham and Women's Hospital, Boston, MA, USA. 3. Department of Surgical Oncology, Banner MD Anderson, Gilbert, AZ, USA. 4. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, USA. 8. Department of Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, TX, USA.
Abstract
BACKGROUND: There is limited data evaluating mastectomy skin flap complications of nipple-sparing mastectomy (NSM) in patients with BRCA gene mutations. The purpose of this study was to identify factors associated with post-operative complications in BRCA mutation carriers undergoing NSM. METHODS: Following institutional review board approval, we interrogated a prospectively collected institutional database for patients undergoing NSM who tested positive for BRCA1/2 mutations. Patient characteristics, preoperative details, and complications were evaluated. Digital mammogram was used to estimate the breast volume. RESULTS: From August 2009 to December 2017, 59 patients (2 males) with BRCA1/2 mutations underwent 114 NSMs. Ninety-two (80%) were risk-reduction surgeries. Thirty-two (28%) underwent single-stage reconstruction (24 autologous). The overall complication rate was 26.3% (N = 30), and 10.5% (N = 12) underwent unanticipated reoperation. 8.8% (N = 10) had full-thickness skin flap necrosis, 10.5% (N = 12) nipple necrosis, and 4.4% (N = 5) full-thickness nipple necrosis. These complications were associated with larger breast volume (799.4 cc vs. 544.1 cc, p < 0.001) and greater body mass index (27.8 vs. 24.3, p < 0.001). By univariate analysis, body mass index and breast volume greater than 675 cc were associated with significantly higher complication rate (odds ratios 1.2 and 4.5 respectively, p = 0.001). CONCLUSIONS: This study confirms that NSM in BRCA1/2 mutation carriers is associated with complications in one in four patients. Utilizing the preoperative mammograms to estimate breast size may be more helpful than breast cup size in counseling preoperatively the risks of complications.
BACKGROUND: There is limited data evaluating mastectomy skin flap complications of nipple-sparing mastectomy (NSM) in patients with BRCA gene mutations. The purpose of this study was to identify factors associated with post-operative complications in BRCA mutation carriers undergoing NSM. METHODS: Following institutional review board approval, we interrogated a prospectively collected institutional database for patients undergoing NSM who tested positive for BRCA1/2 mutations. Patient characteristics, preoperative details, and complications were evaluated. Digital mammogram was used to estimate the breast volume. RESULTS: From August 2009 to December 2017, 59 patients (2 males) with BRCA1/2 mutations underwent 114 NSMs. Ninety-two (80%) were risk-reduction surgeries. Thirty-two (28%) underwent single-stage reconstruction (24 autologous). The overall complication rate was 26.3% (N = 30), and 10.5% (N = 12) underwent unanticipated reoperation. 8.8% (N = 10) had full-thickness skin flap necrosis, 10.5% (N = 12) nipple necrosis, and 4.4% (N = 5) full-thickness nipple necrosis. These complications were associated with larger breast volume (799.4 cc vs. 544.1 cc, p < 0.001) and greater body mass index (27.8 vs. 24.3, p < 0.001). By univariate analysis, body mass index and breast volume greater than 675 cc were associated with significantly higher complication rate (odds ratios 1.2 and 4.5 respectively, p = 0.001). CONCLUSIONS: This study confirms that NSM in BRCA1/2 mutation carriers is associated with complications in one in four patients. Utilizing the preoperative mammograms to estimate breast size may be more helpful than breast cup size in counseling preoperatively the risks of complications.
Authors: Ko Un Park; Sandy Lee; Angela Sarna; Matthew Chetta; Steven Schulz; Doreen Agnese; Valerie Grignol; William Carson; Roman J Skoracki Journal: BMJ Open Date: 2021-11-15 Impact factor: 2.692