Nipple-Sparing Surgery is Safe for Women with Gene Mutations

By Constance M. Chen, MD, MPH

For women with a genetic predisposition to breast cancer, it is shocking to learn that you carry a gene mutation that dramatically increases the chance you will develop breast cancer at some point in your life. Perhaps just as shocking is learning that your best way to prevent breast cancer is to undergo a double mastectomy that changes your body forever. For these women, one way to optimize survival while preserving breast shape is to undergo nipple-sparing mastectomies. Sparing a woman’s nipples has been shown to be safe to preserve life while minimizing deformities.

While a woman at average risk of breast cancer stands a 1 in 8 chance of developing breast cancer at some point in her life, for women who have inherited genetic mutations for breast cancer the odds are far higher. For example, for women with the BRCA1 or BRCA2 genetic mutation, the gene that suppresses tumor growth is hindered so that their chance of developing breast cancer by age 80 is raised to about 70%, according to a 2021 study in the Annals of Surgical Oncology.

The most effective approach to prevent breast cancer in women with a genetic mutation is a double mastectomy. For example, in women with the BRCA mutation, prophylactic mastectomy reduces the risk of breast cancer by an astounding 95%.

Women with a genetic mutation predisposing them to breast cancer face a terrible choice: to lower their cancer risk to an acceptable level, they must lose their natural breasts. Fortunately, however, preserving their nipples—an integral part of the breast and a woman’s body image—is possible for the vast majority of those who undergo a preventive mastectomy as long as they find a breast surgeon with the skill set to do this type of specialized mastectomy.

Who is eligible for nipple-sparing procedures?  

It should be noted that most, but not all, women with BRCA gene mutations are considered eligible for nipple-sparing mastectomy. While most cancers develop deep in the breast tissue—leaving the nipple and surrounding tissue unaffected—some breast cancers can occur within this tissue.

Diligent screening is done to rule out the presence of breast cancer in the nipple. Bloody nipple discharge or other unusual symptoms might suggest a higher risk for breast cancer in the nipple, so women with these issues would likely not be eligible for a nipple-sparing procedure. But for most women with genetic mutations, choosing a nipple-sparing mastectomy frees them from the specter of breast cancer while allowing them to maintain their sense of self.

Affirming new research  

A landmark 2017 report in the Journal of the American Medical Association showed that nipple-sparing mastectomy in women virtually eliminates the risk of cancer in the reconstructed breast. The study confirmed that even women with genetic mutations can confidently undergo nipple-sparing mastectomy followed by breast reconstruction to preserve breast appearance.

Multiple studies published since then have only reinforced those findings. A 2021 study in the journal Genes suggested that nipple-sparing mastectomy among BRCA mutation carriers is linked with “low reported rates of new breast cancers, low rates of post-operative complications, and high levels of satisfaction and post-operative quality of life.”

A 2021 paper in Annals of Surgical Oncology tracked nearly 250 women who underwent prophylactic nipple-sparing mastectomy and showed an “extremely low” chance of breast cancer occurrence after an average of 3.5 years.

It’s highly encouraging that current studies support the safety of a woman’s choice to keep her nipples when undergoing mastectomy. Combined with breast reconstruction, nipple-sparing mastectomy makes a difficult situation much easier to tolerate, both physically and psychologically.

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com