Oncological safety of prophylactic breast surgery: skin-sparing and nipple-sparing versus total mastectomy

BRCA1/2 mutation carriers have a cumulative lifetime breast cancer risk of 55-85% by the age of 70 (1-5). As an alternative to surveillance, BRCA1 and BRCA2 mutation carriers and other women with a high breast cancer risk may choose to undergo bilateral prophylactic mastectomy, reducing breast cancer risks by 90-100% after 3-13 years of follow-up (6-10). The prophylactic character of the bilateral mastectomy emphasizes the importance of a natural aesthetic outcome (11), which can be achieved by various immediate autologous and implant breast reconstruction techniques. Instead of the conventional total mastectomy, to allow for an immediate breast reconstruction and to achieve a natural aesthetic outcome so-called conservative mastectomies are increasingly performed for risk reduction. In conservative mastectomies, all breast glandular tissue is removed while leaving the skin envelope and, if spared, the nipple-areola complex (NAC) in situ [skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM), respectively]