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James W. Jakub, M.D., Breast Surgeon, Mayo Clinic: Patients with a genetic mutation that increase the risk of developing breast cancer have many options to consider. Options include one) more intensive screening, two) preventative medications, and three) risk-reducing mastectomies.
I would like to spend the next two minutes addressing the specific question regarding saving one's nipple during a risk-reducing mastectomy. Risk-reducing mastectomies offer the highest method of prevention against future breast cancers for patients who have a gene mutation. Although mastectomies do not completely eliminate the risk of breast cancer, they provide risk reduction in the range of 90 to 95%. It is important to note, however, that it has not been established that risk-reducing mastectomies improve survival compared to intensive screening. Whereas mammograms, MRI's and other imaging approaches have the goal of early detection, mastectomies are actually a risk-reducing approach intended to prevent the development of ever getting a breast cancer.
There has been an increased interest in preventative mastectomies by patients, primarily because of the improved and sometimes exceptional cosmetic results that can be achieved. One of these techniques is referred to as a nipple-sparing mastectomy with immediate reconstruction. This procedure is discussed in greater detail in some of our other videos, but the point I wish to highlight is a nipple-sparing mastectomy should be discussed with patients who are considering risk-reducing mastectomies.
A nipple-sparing approach allows an individual to keep all of her skin, including her nipple and areola, and the procedure is performed combined with a plastic surgeon in which the reconstruction is started at the same operation.
One major concern among providers and patients has been, is it safe to keep the nipple in cases of a genetic mutation. The short answer based on a recent study led by Mayo Clinic is yes. It does appear to be safe. In our recent multi-institutional study of 548 risk-reducing mastectomies performed in 346 patients with BRCA mutations, zero cancer is developed in three to five years of follow up. It would have been expected that approximately 22 of these high-risk women would have developed breast cancer in this time period without any intervention.
Although no prevention strategy is 100% protective, and we are looking forward to having longer-term follow up from our study and others, nipple-sparing mastectomy is one option women at elevated risk of breast cancer should discuss with their physicians if they are considering a risk-reducing mastectomy.
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