Use of Mammographic Measurements to Predict Complications After Nipple-Sparing Mastectomy in BRCA Mutation Carriers

Ko Un Park, Anna Weiss, Kelly Rosso, Min Yi, Kelly K Hunt, Henry Mark Kuerer, Summer Elizabeth Hanson, Rosalind Pitpitan Candelaria, Sarah Tevis, Alastair Thompson

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
JournalAnnals of surgical oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Nipples
Mastectomy
Breast
Mutation
Necrosis
Body Mass Index
Skin
Research Ethics Committees
Risk Reduction Behavior
Reoperation
Counseling
Odds Ratio
Databases
Genes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{cb1f4cb6bdb940f69979706088d7dc5c,
title = "Use of Mammographic Measurements to Predict Complications After Nipple-Sparing Mastectomy in BRCA Mutation Carriers",
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.",
author = "Park, {Ko Un} and Anna Weiss and Kelly Rosso and Min Yi and Hunt, {Kelly K} and Kuerer, {Henry Mark} and Hanson, {Summer Elizabeth} and Candelaria, {Rosalind Pitpitan} and Sarah Tevis and Alastair Thompson",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07704-1",
language = "English (US)",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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TY - JOUR

T1 - Use of Mammographic Measurements to Predict Complications After Nipple-Sparing Mastectomy in BRCA Mutation Carriers

AU - Park, Ko Un

AU - Weiss, Anna

AU - Rosso, Kelly

AU - Yi, Min

AU - Hunt, Kelly K

AU - Kuerer, Henry Mark

AU - Hanson, Summer Elizabeth

AU - Candelaria, Rosalind Pitpitan

AU - Tevis, Sarah

AU - Thompson, Alastair

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1245/s10434-019-07704-1

DO - 10.1245/s10434-019-07704-1

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