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New research by the Mayo Clinic in Rochester, Minnesota and other research institutions has found that protective mastectomies that preserve the nipple and surrounding skin are as effective at preventing breast cancer as more radical surgery.

Women with a mutation in the BRCA gene can have an increased risk of developing breast cancer – and as a result, may elect to undergo mastectomy as a preventative measure.

More invasive surgery removes the nipple and surrounding tissue as a precautionary measure.

However, lead researcher and breast surgeon Dr James Jakub from the Mayo Clinic says that nipple-sparing surgery can be as effective as more invasive surgery in preventing breast cancer in those who are BRCA-positive.

“Nipple-sparing mastectomy is gaining wide acceptance because of its superior cosmetic results, but pockets of the medical community remain sceptical that it is the right choice for the BRCA population,” said Dr Jakub.

“This is the largest study of its kind to address the controversy – and to show that nipple-sparing mastectomy is as effective at preventing breast cancer as traditional mastectomy.”

The Mayo Clinic team and colleagues studied outcomes among 348 patients, who collectively had 551 mastectomies performed at nine institutions between 1968 and 2013.

The study included 203 women who had both breasts removed protectively, known as a bilateral mastectomy – and 145 patients who had one breast removed preventively, after cancer occurred in the other breast.

The research shows that, none of the patients who had a bilateral nipple-sparing mastectomy developed breast cancer at any site after an average of three to five years of follow-up – and no breast cancers developed in the retained skin, nipples, or lymph nodes on the side of the prophylactic procedure.

A total of seven women died from breast cancer during follow-up – in all these cases, the patients had a previous or concurrent breast cancer at the time of surgery, and their stage 4 disease (where breast cancer has spread to other parts of the body) was attributed to that cancer.

In 2009, approximately 8% of mastectomies performed at the Mayo Clinic were nipple-sparing – however, by 2014, approximately 30% of mastectomies were nipple-sparing and the number is increasing, says Dr Jakub.

“There is no question that this option of nipple-sparing mastectomy can often provide an outstanding cosmetic result – and may make it easier for women who are at risk to take this preventive measure,” he added.

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